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Admission Not Necessary for Many ER Patients With Chest Pain

Vast majority who have normal cardiac test results are in no immediate danger, researchers say

TUESDAY, May 19, 2015 (HealthDay News) -- Adverse cardiac events are rare among adult patients presenting with chest pain with two negative findings for serial biomarkers, nonconcerning vital signs, and nonischemic electrocardiographic findings, according to research published online May 18 in JAMA Internal Medicine.

Michael Weinstock, M.D., a professor of emergency medicine at The Ohio State University College of Medicine in Columbus, and colleagues looked at data from 11,230 visits by patients experiencing chest pain to three hospitals in Columbus between 2008 and 2013.

Overall, the researchers found a low short-term risk of clinically relevant adverse cardiac events among patients with chest pain who have normal cardiac blood tests, vital signs, and electrocardiograms. Of these patients, four in the study group (0.06 percent of patients) developed a clinically relevant adverse cardiac event such as life-threatening arrhythmia, inpatient ST-segment elevation myocardial infarction, cardiac or respiratory arrest, or death. The team determined that two of these events were noncardiac and two were possibly iatrogenic.

"This data shows routine hospital admission is not the best strategy for this group," Weinstock said in a university news release. "We tend to admit a lot of people with chest pain out of concern for missing a heart attack or some other life-ending irregularity. To me, this [new finding] says we can think more about what's best for the patient long term."

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