New Strategy Discovered to Lower Unnecessary Hospital Admissions for Chest Pain

A new research found an effective strategy to lower the rate of unnecessary hospital admissions for chest pain.

One of the most common reasons for emergency hospital admission is chest pain. In most of the countries, incidence of premature death due to heart disease and stroke remains high. The novel strategy proposed by researchers at the Manchester University to lower unnecessary hospital admission for chest pain includes combination of clinical judgment combined with electrocardiogram (ECG) and blood test on arrival.

Studies conducted earlier highlighted that the typical symptoms in those presented at the emergency departments have not been useful in differentiating between heart conditions that require immediate hospital admission and non-cardiac conditions. According to the researchers, the new strategy could potentially make a huge difference.

The reason why healthcare practitioners find it challenging to differentiate between the conditions is because the symptoms of patients with heart disease can be similar to those experienced by patients with non-cardiac conditions, such as indigestion. However, the overall role of clinical judgment has not been studied extensively.

The diagnostic accuracy of emergency doctor's clinical judgment for acute coronary syndromes (ACS) was assessed by Richard Body, Consultant in Emergency Medicine at Manchester Royal Infirmary. He also assessed ECG and blood test that detects protein called troponin.

In this study, the doctors in the emergency department recorded their clinical judgment for ACS using a five-point Likert scale. The data was then compared with the outcomes of the patients including heart attack or the occurrence of major adverse cardiac event within 30 days.

The researchers noticed that those who were suspected to have an ACS, clinical diagnosis alone could not be relied upon to rule out or rule in diagnosis. But, when combined with ECG and troponin test, clinical judgment turned out to be effective tool and the results showed that 25 percent of the admissions could have been avoided.

"It is still early days but the study, which was funded through an NIHR Clinical Lecturer grant and a College of Emergency Medicine Research Grant, could potentially make a huge difference to large numbers of patients. In order to ensure the safety of patients, further research is still vital to ensure that our findings can be repeated with different groups of doctors and patients. We will also need to know if doctors would be confident enough in their judgement to use the technique in practice," Dr Rick Body, who is also National Institute for Health Research Postdoctoral Research Fellow, explained.

The finding was documented in the Emergency Medicine Journal.