The chest pain choice decision aid: a randomized trial

Area of Science:

• Cardiology
• Health Services Research
• Patient Decision Making

Background:

• Cardiac stress testing in low-risk acute coronary syndrome patients often yields false positives, leading to unnecessary procedures and costs.
• Patient preferences are unlikely to be the primary driver for obtaining these tests.

Purpose of the Study:

• To evaluate the impact of a decision aid on patient knowledge and decision-making for chest pain management.
• To assess the effect of a decision aid on the rate of observation unit admission for cardiac stress testing.

Main Methods:

• Prospective randomized trial (Chest Pain Choice) with 204 patients.
• Intervention group received a decision aid detailing risks, benefits, and management options.
• Control group received usual care; outcomes assessed over 30 days.

Main Results:

• Decision aid group showed significantly higher patient knowledge (3.6 vs. 3.0 correct answers).
• Decision aid group demonstrated greater engagement in decision-making (OPTION scores 26.6 vs. 7.0).
• Fewer patients in the decision aid group opted for observation unit admission for stress testing (58% vs. 77%).

Conclusions:

• Decision aids enhance patient understanding and involvement in care choices.
• Implementing decision aids can reduce unnecessary cardiac stress testing and observation unit admissions.
• No major adverse cardiac events were observed in either group post-discharge.