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Chest pain and heart attack evaluation processes introduced to emergency departments in recent years have contributed to reducing聽unnecessary testing, hospital stays and costs.

Researchers evaluated chest pain and heart attack risk in emergency departments (EDs) in two landmark聽articles published in the , finding improved outcomes for EDs and patients.

The studies were jointly led by specialists at the (RBWH) 鈥� Professor Will聽Parsonage (cardiologist and clinical director of the at the Queensland聽University of Technology) and Professor Louise Cullen (pre-eminent staff specialist in emergency medicine).

The first, the Accelerated Chest pain Risk Evaluation (ACRE) project, tested the effect of an accelerated diagnostic聽protocol (ADP) for patients presenting to EDs with chest pain.聽鈥淐hest pain is among the most common primary problems with which patients present to EDs. Excluding acute聽coronary syndrome (ACS) in most patients without missing cases requires a conservative approach, but places a聽considerable burden on service delivery,鈥� Professor Parsonage and colleagues wrote.

The ADP 鈥� the 2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using聽contemporary Troponins as the only biomarker (ADAPT) 鈥� was introduced in 16 Queensland hospitals during October 2013 to November 2015.

Outcomes were recorded for 30,769 patients presenting before and 23,699聽presenting after the ADP was introduced. Following its implementation, 21.3% of patients were identified by the ADP聽as being at low risk for an ACS; the mean ED length of stay for all patients presenting with chest pain fell from 292 to聽256 minutes. The mean hospital length of stay fell from 57.7 to 47.3 hours, and the hospital admission rate fell from聽68.3% to 54.9%. An estimated $2.3 million in financial capacity was released as the result of reduced ED length of聽stay and $11.2 million through fewer hospital admissions.

The second study tested the safety and efficacy of another ADP, the Improved Assessment of Chest pain Trial聽(IMPACT).

IMPACT was introduced at the RBWH during February 2011 to March 2014. A total of 1366 patients presenting to the聽ED with symptoms of suspected ACS were stratified into groups at low, intermediate or high risk of an ACS.

High risk聽patients were treated according to current guidelines, while low and intermediate risk patients underwent troponin聽testing (with a sensitive assay) at presentation and two聽hours later. Intermediate risk patients underwent objective聽testing after the second troponin test; low risk patients were discharged without further objective testing.

鈥淭he IMPACT protocol stratified 244 (17.9%) patients to low risk, 789 (57.7%) to intermediate risk and 333 (24.4%) to聽high risk categories,鈥� Professor Cullen and colleagues wrote. 鈥淭he overall 30-day ACS rate was 6.6%, but there were聽no ACS events in the low risk group, and 14 (1.8%) in the intermediate risk group. The median hospital length of stay聽was 5.1 hours for low risk and 7.7 hours for intermediate risk patients.

鈥淭he IMPACT protocol safely and efficiently allowed a large proportion of patients presenting to EDs with chest pain to聽undergo accelerated assessment for risk of an ACS.

鈥淭hree-quarters of patients presenting to EDs with chest pain can be rapidly assessed using modified risk stratification聽criteria, early serial troponin testing and selective objective testing. Reducing unnecessary objective testing of聽patients at low risk of an ACS should be encouraged,鈥� the authors concluded.

Image credit: 漏stock.adobe.com/au/Shakzu