Low Risk Of Adverse Cardiac Events in Patients With Negative ER Evaluation For Chest Pain

Michael B. Weinstock, MD Professor of Emergency Medicine, Adjunct Department of Emergency Medicine, The Ohio State University College of Medicine Emergency Department Chairman and Director of Medical Education, Mt. Carmel St. Ann's Dept. of Emergency Medicine Columbus, OhioMedicalResearch.com Interview with:
Michael B. Weinstock, MD
Professor of Emergency Medicine, Adjunct
Department of Emergency Medicine, The Ohio State University College of Medicine
Emergency Department Chairman and Director of Medical Education, Mt. Carmel St. Ann’s Dept. of Emergency Medicine
Columbus, Ohio

Medical Research: What is the background for this study?

Response: Patients with potential cardiac ischemia are often admitted to the hospital even after a negative evaluation in the emergency department due to concern about missed MI, unstable angina, or potential for cardiac arrhythmia.

Medical Research: What are the main findings?

Response: Our study was different than previous studies and clinical decision rules; instead of looking at a 30 day marker, which is important to the cardiologist, ours looked at the risk of a Clinically Relevant Adverse Cardiac Event (CRACE) occurring during hospitalization. These events included inpatient STEMI, life-threatening arrhythmia, cardiac or respiratory arrest, or death. The study found only 4 of these events out of 7266 patients studied and of the 4, two were possibly iatrogenic, suggesting that after a negative ED evaluation (including 2 negative serial cardiac enzyme tests, non-ischemic and interpretable ECG, and nonconcerning vital signs) a patient can be safely sent home for an expedited cardiac outpatient evaluation.

Medical Research: What should clinicians and patients take away from your report?

Response: Using a model of shared decision making at the bedside in the Emergency Department we now have a number to give the patient about their risk of a short-term adverse event. This study suggests patients can be safely have their evaluation completed in an expedited manner as an outpatient.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Perform this study in a prospective manner to assess specific risks of discharge as well as risks of hospitalization.

Citation:

 

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MedicalResearch.com Interview with: Michael B. Weinstock, MD (2015). Low Risk Of Adverse Cardiac Events in Patients With Negative ER Evaluation For Chest Pain 

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