Mayo: Chest pain units save lives, hospitalizations

One more study shows benefit of observation units

Researchers at the Mayo Clinic in Rochester, MN, have determined some patients who visit the emergency department (ED) with chest pain can be evaluated safely and effectively without expensive hospitalization.1

"The results were so promising that we converted the chest pain observation unit into our everyday clinical practice within one month of completing the study," says Peter Smars, MD, a Mayo Clinic emergency medicine specialist and principal investigator.

The majority of patients with acute chest pain are usually admitted to the hospital for two to three days at an individual cost averaging more than $4,000; and 6,000 to 10,000 die after inadvertently being sent home when they are actually having a heart attack.

Facing patients with unstable angina

The researchers used a specially designed chest pain observation unit in the ED to evaluate patients with unstable angina by administering standard therapy and diagnostic tests — aspirin, heparin, continuous ST-segment monitoring, determination of creatine kinase isoenzyme levels, and a study of cardiac function.

"After six to nine hours of observation, we were able to dismiss nearly half of the study group, avoiding inconvenience for the patient and providing the highest quality care at a significant cost savings," said Smars.

No patients evaluated and dismissed suffered a primary cardiac event in the subsequent six months. For those 212 who were hospitalized after observation, the risk of a subsequent primary cardiac event was not significantly different when compared with a group of patients who underwent traditional hospitalization procedures.

Reference

1. Farkouh ME, Smars PA, Reeder GS, et al. A clinical trial of a chest pain observation unit for patients with unstable angina. N Engl J Med 1998; 339:1,882-1,888.