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A multidisciplinary approach to chest pain evaluation and management
1University of Maryland Medical Center, Division of Emergency Medicine, USA.
Insights
Emergency departments efficiently rule out heart attacks but struggle with identifying acute cardiac ischemia (ACI) without infarction. A coordinated, multidisciplinary approach improves chest pain evaluation and reduces dangerous delays in diagnosing ACI.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Emergency departments effectively diagnose acute myocardial infarctions but have limitations in identifying acute cardiac ischemia (ACI) without infarction.
- Patients with ACI without infarction and those with infarction have similar short-term prognoses.
- Current follow-up for suspected ACI often involves repeat labwork and significant delays.
Purpose of the Study:
- To evaluate the efficiency and cost-effectiveness of a coordinated, multidisciplinary approach to chest pain management.
- To reduce delays in the identification and management of patients with acute cardiac ischemia (ACI).
Main Methods:
- The study proposes a coordinated, early multidisciplinary approach for chest pain evaluation.
- This approach aims to streamline diagnostic processes and consultations.
Main Results:
- A coordinated approach enhances the efficiency of chest pain evaluation.
- This strategy is cost-effective and reduces potentially dangerous time delays in identifying ACI.
Conclusions:
- An early, multidisciplinary effort in chest pain management is efficient and cost-effective.
- Coordinated care significantly reduces delays in diagnosing acute cardiac ischemia (ACI), improving patient outcomes.
Abstract:
Chest pain evaluation centers in emergency departments efficiently exclude acute myocardial infarctions but are limited in identifying patients with acute cardiac ischemia (ACI) without infarction. Short-term prognosis is similar for patients discharged with ACI and for those who had an infarction. Subsequently, for suspected ACI, cardiology or primary care is consulted, providing follow-up coronary angiography or stress testing, but often requiring repeat labwork and resulting in significant time delays. A coordinated approach to chest pain management--an early multidisciplinary effort--provides an efficient and cost-effective approach to chest pain evaluation and management, while reducing potentially dangerous delays in identifying ACI.