Evidence map›Paper›PMID 31321618›Full record

ArticleJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology2020

Clinical effectiveness of an outpatient pathway for low-risk chest pain emergency department visits.

Besiana Liti, Felix Krainski, Andre Gabriel, Brett Hiendlmeyr, Akrivi Manola, William Perucki, Gene Pershwitz, Ajay Kumar, W Lane Duvall

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Article in Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Besiana LitiDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Felix KrainskiDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Andre GabrielDepartment of Medicine, University of Connecticut Medical Center, Farmington, CT, USA.
Brett HiendlmeyrDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Akrivi ManolaDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
William PeruckiDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Gene PershwitzDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Ajay KumarDepartment of Medicine, Hartford Hospital, Hartford, CT, USA.
W Lane DuvallDivision of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA. lane.duvall@hhchealth.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundStudies suggest that patients who present with atypical chest pain and are low or low-intermediate risk can safely undergo a rapid rule-out for cardiac ischemia with serial ECGs and cardiac biomarkers followed by additional testing as needed. We sought to evaluate a novel Emergency Department (ED) protocol for patients to undergo their additional functional testing as an outpatient.

methodsPatients presenting to the ED with atypical chest pain, normal ECG, and negative cardiac troponin felt to be low risk were referred for outpatient stress testing within 72 hours of presentation as part of a pilot program. We analyzed test characteristics, length of stay, and 30-day return visits to ED in the pilot group and compared results to a similar cohort assessed in the ED by a traditional chest pain observation protocol.

resultsA total of 156 patients were included over a 5-month period with 29.5% not returning for testing. There was a 70% reduction in length of stay for outpatient stress test protocol patients. All-cause and cardiac return visits to the ED were not significantly different between the outpatient cohort and the traditional chest pain unit group and were reduced by 47 and 75%, respectively, in patients who completed their outpatient testing. The provisional injection protocol resulted in a 81% reduction in radiation exposure when compared to traditional MPI stress protocols due to a greater utilization of exercise treadmill tests without imaging.

conclusionOutpatient stress testing is a reliable alternative to traditional chest pain observation with a significantly shorter length of stay, reduced healthcare costs, and improved radiation safety profile for patients when compared to traditional inpatient observation.

Indexed as

Emergency Service, HospitalAdultChest PainElectrocardiographyExercise TestFemaleHumansLength of StayMaleMiddle AgedOutpatientsRetrospective StudiesTreatment OutcomeCoronary artery diseaseEmergency departmentExercise treadmill testMyocardial perfusion imagingSPECT

Identifiers

PMID31321618

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.