Chest pain unit implementation in a multidisciplinary hospital: a retrospective observational study

Acute chest pain is a common reason for emergency department visits and requires rapid differentiation between life-threatening and non-life-threatening conditions. Chest Pain Units (CPUs) were developed to improve diagnostic efficiency and optimize management of patients with suspected acute coronary syndrome (ACS). This study evaluated clinical and healthcare utilization patterns before and after CPU implementation in a multidisciplinary hospital in Kazakhstan.

A retrospective case-control study was conducted at a 250-bed tertiary hospital. Two consecutive periods were analyzed: pre-implementation (2015-2017) and post-implementation (2018-2020) of CPU. Patients presenting before CPU implementation received standard emergency department care (non-CPU group, n = 1,595), whereas those presenting after implementation were managed in the CPU (n = 2,121). All consecutive patients with suspected ACS (ICD-10 I20-I22) were included (total n = 3,716). Final diagnoses were based on discharge ICD-10 coding. The CPU protocol included standardized assessment, electrocardiography, serial cardiac troponin measurements, and HEART pathway risk stratification. Outcomes included invasive procedures, mortality, hospital length of stay, and direct treatment costs.

Baseline characteristics showed a higher proportion of men in both groups (p = 0.015), with no significant age difference (p = 0.066). The CPU group had a higher PCI rate (OR 1.43, 95% CI 1.26-1.64, p < 0.001), whereas diagnostic angiography was more frequent in the non-CPU group (OR 0.76, 95% CI 0.67-0.87, p = 0.02). No significant difference was observed for CABG (p = 0.07). AMI diagnoses were more frequent in the CPU group (37.6% vs. 25.1%; OR 1.80, 95% CI 1.57-2.09, p < 0.001), while unstable angina was more common in the non-CPU group (OR 0.50, 95% CI 0.48-0.64, p < 0.001). Mortality did not differ significantly between groups (2.4% vs. 2.2%, p = 0.543). Direct treatment costs were significantly higher following CPU implementation (p < 0.001).

CPU implementation was associated with higher rates of AMI identification and increased PCI use compared with the traditional emergency department approach. CPU-based pathways may improve diagnostic accuracy and management patterns in patients with suspected ACS.