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Many ER Patients With Chest Pain Can Be Sent Home, Study Finds

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

MONDAY, May 18, 2015 (HealthDay News) -- While chest pain sends many people to the nearest hospital emergency department, most patients may not need a costly hospital stay as a result, a new study suggests.

According to a news release from Ohio State University, chest pain sends more than 7 million Americans to the ER every year and about half of them are then admitted for further observation, testing or treatment.

But is the cost and inconvenience of a hospital stay always warranted?

The study aimed to "assess whether this population of patients could safely go home and do further outpatient testing within a day or two," lead researcher Dr. Michael Weinstock, a professor of emergency medicine at the university's College of Medicine, said in the news release.

His team looked at data from more than 11,000 visits by patients experiencing chest pain to three hospitals in Columbus, Ohio between 2008 and 2013.

Only four people in the study group -- working out to just 0.06 percent of patients -- developed a life-threatening heart rhythm, suffered a heart attack or cardiac or respiratory arrest, or died, Weinstock's team found.

Overall, the study found a low short-term risk of life-threatening heart problems among patients with chest pain who have normal cardiac blood tests, vital signs and electrocardiograms. The results are published May 18 in the journal JAMA Internal Medicine.

"This data shows routine hospital admission is not the best strategy for this group," Weinstock said. "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."

Plus, patients who visit the ER for chest pain often wish to return home as soon as possible, Weinstock said.

"I've been having these conversations with my patients, and only one wanted to stay in the hospital," he said. "Most people want to go home and get tests done the next day."

The researchers called for a reassessment of current national guidelines to routinely admit, observe and test patients with chest pain who have received a "clean" evaluation in the ER.

"We'd like to see more emergency medicine physicians having that bedside conversation to ensure the chest pain patient knows the risks and benefits of hospitalization compared to outpatient evaluation. We think continuing evaluation in an outpatient setting is not only safer for the patient, it's a less costly approach for the health care system," Weinstock said.

Two experts who reviewed the study agreed that early discharge from the hospital may work for many patients with chest pain.

Prompt discharge for patients with normal test results "is safe and will likely improve efficacy in an era of continued attempts to reduce growing health care costs," said Dr. Kevin Marzo, chief of cardiology at Winthrop-University Hospital in Mineola, N.Y.

Dr. Eric Cruzen, medical director of the Lenox Hill HealthPlex in New York City, said that "the results of this study may help to better select which patients are likely to benefit from hospital admission and which patients may be safely sent home."

More information

The U.S. National Library of Medicine has more about chest pain.

SOURCES: Eric Cruzen, M.D., chairman and medical director, Lenox Hill HealthPlex, New York City; Kevin Marzo, M.D., chief of cardiology, Winthrop-University Hospital, Mineola, N.Y.; Ohio State University, news release, May 18, 2015
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