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[The clinical care pathway of patients with chest pain]
Giuseppe Di Tano1, Roberto Bonatti2
1U.O. Cardiologa, Ospedale ASST, Cremona.
Insights
Diagnosing chest pain is challenging due to diverse causes and increasing emergency visits. Implementing hospital networks can improve acute coronary syndrome diagnosis and patient outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Chest pain evaluation is complex, with rising emergency department visits.
- Key challenges include missed acute coronary syndromes and hospitalizing low-risk patients, leading to increased costs and complications.
- Accurate diagnosis is crucial for effective treatment strategies.
Purpose of the Study:
- To highlight the diagnostic challenges of chest pain.
- To emphasize the need for improved diagnostic accuracy and efficient patient management.
- To advocate for collaborative hospital networks to optimize care.
Main Methods:
- Review of common presentations and diagnostic challenges in chest pain.
- Discussion of current issues like missed diagnoses and unnecessary hospitalizations.
- Proposal for implementing 'hub and spoke' hospital networks.
Main Results:
- Increasing emergency department presentations for chest pain.
- Significant risks associated with missed acute coronary syndromes.
- Potential for hospital networks to reduce delays and improve outcomes.
Conclusions:
- Chest pain diagnosis remains challenging, necessitating careful assessment.
- Hospital networks can enhance care delivery for acute chest pain patients.
- Collaboration between cardiologists and emergency physicians is vital for network success.
Abstract:
Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes and its evaluation remains challenging. The proportion of patients presenting to the emergency department because of acute chest pain appears to be increasing. Nowadays, the essential chest pain-related issues are the missed diagnoses of acute coronary syndromes with a poor short-term prognosis and the increasing percentage of hospitalizations of low-risk cases. It is well known that hospitalization of a low-risk chest pain patient can lead to unnecessary tests and procedures, with an increasing trend of complications and burden of costs, but chest pain is never low risk and appropriate diagnosis is always mandatory. The correct diagnosis will guide the treatment strategy. The implementation of networks between hospitals (hub and spoke) with various levels of technology, provide optimal care while minimizing delays, thereby improving clinical outcomes. Cardiologists should actively collaborate with all stakeholders, particularly emergency physicians, in establishing such networks.
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