Clinical InvestigationCoronary Artery DiseaseThe role of primary care physician and cardiologist follow-up for low-risk patients with chest pain after emergency department assessment
Section snippets
System context
The Canadian health insurance system provides free universal coverage for all essential ambulatory and emergency medical services for all its citizens. Patients do not have to pay any fees when seeking assessment in the ED or seeing PCP or cardiologists in the outpatient setting. The Ontario Drug Benefit program is a government-funded drug benefit program that covers outpatient drug costs for all Ontario residents aged ≥65 years.
Study sample
Our study sample included low-risk patients discharged home from
Study population
Of the 805,760 patients who presented to an Ontario ED with chest pain between April 1, 2004, and March 31, 2010, we excluded 115,332 patients because of hospitalization from the ED, 29,919 patients who had repeat visits with chest pain or were hospitalized with an acute coronary syndrome within 30 days, and 1,626 patients who died within 30 days of assessment. Patients who were not assigned a physician group such as seeing a noncardiology specialist (52,421 patients) and patients with
Discussion
Our study extends current knowledge in the transition of care after ED assessment for patients with chest pain. Despite practice guidelines recommending physician follow-up after chest pain evaluation, 29% of patients did not visit any physician in 30 days after ED assessment.3, 4 Importantly, we found that PCP with cardiologist follow-up was associated with 19% reduced hazard of death or MI and 27% reduced hazard of death compared with no follow-up. Patients who saw a cardiologist alone at
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Cited by (22)
Clinical outcomes for chest pain patients discharged home from emergency departments using high-sensitivity versus conventional cardiac troponin assays: High-sensitivity vs conventional troponin in EDs
2020, American Heart JournalCitation Excerpt :Accordingly, a large population-based observational study is likely the best possible study design to examine the impact of real-world adoption of troponin assays. Second, although the characteristics of EDs differed in terms of their academic status and locations, we have previously demonstrated that admission thresholds of EDs across Ontario are not substantially different, likely indicating the similarity of evaluating and managing patients presented to EDs with chest pain.17,18,22,25 Third, we did not have clinical information such as characteristics of chest pain or findings on electrocardiograms, which would provide further insight into each ED's chest pain patient population and management.
Impaired renal function is associated with adverse outcomes in patients with chest pain discharged from internal medicine wards
2018, European Journal of Internal MedicineCitation Excerpt :Finally, our database did not include information regarding different potential confounders including echocardiographic parameters, medical follow-up, renal function assessment, stress testing and medical treatment post hospital discharge. It has been well demonstrated that for patients who presented to an emergency department with chest pain, follow-up with a cardiologist was associated with significantly reduced risk of death or myocardial infarction at 1 year [21,22] In conclusion, we found an independent graded association between lower eGFR and the risk of death and hospital admissions for ACS among patients with chest pain who were discharged from internal medicine wards following an ACS-rule-out.
Heart-focused anxiety and health care seeking in patients with non-cardiac chest pain: A prospective study
2018, General Hospital PsychiatryCitation Excerpt :Current guidelines recommend a physician follow-up shortly after discharge from the ED after a consultation for NCCP [53,54]. Previous studies report that, within 30 days following the discharge after an episode of NCCP, up to 29% of the patients had not consulted at all, up to 69% of the patients consulted a primary care physician, and up to 17% of the patients had seen a cardiologist [53–55]. Our results showed a higher prevalence of medical consultations and also a higher consultation rate with cardiologists.
Dr Lee is supported by a Canadian Institutes of Health Research (CIHR) (Ottawa, Ontario, Canada) Clinician Scientist Award. Dr Schull is supported by a CIHR Applied Chair in Health Services and Policy Research. Dr Tu is supported by a Canada Research Chair in Health Services Research and a Career Investigator Award from the Heart and Stroke Foundation of Ontario (Toronto, Ontario, Canada). Dr Wijeysundera is supported by a Distinguished Clinical Scientist Award from the Heart and Stroke Foundation of Canada. Dr Ko is supported by a Clinician Scientist Award from the Heart and Stroke Foundation of Ontario.
This study was supported by the Institute for Clinical Evaluative Sciences (Toronto, Ontario, Canada), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (Ontario, Canada). There are no financial relationships with any organizations that might have an interest in the submitted work in the previous 2 years; no other relationships or activities that could appear to have influenced the submitted work. None of the listed organizations endorse this study nor do they have any influence on its publication.