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The role of primary care physician and cardiologist follow-up for low-risk patients with chest pain after emergency department assessment

Background Chest pain is one of the most common reasons for presentation to the emergency department (ED); however, there is a paucity of data evaluating the impact of physician follow-up and subsequent management. To evaluate the impact of physician follow-up for low-risk chest pain patients after... Full description

Journal Title: The American heart journal 2014, Vol.168 (3), p.289-295
Main Author: Czarnecki, Andrew, MD
Other Authors: Wang, Julie T., MSc , Tu, Jack V., MD, PhD , Lee, Douglas S., MD, PhD , Schull, Michael J., MD, MSc , Lau, Ching, MD , Farkouh, Michael E., MD, MSc , Wijeysundera, Harindra C., MD, PhD , Ko, Dennis T., MD, MSc
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: United States: Elsevier Inc
ID: ISSN: 0002-8703
Link: https://www.ncbi.nlm.nih.gov/pubmed/25173539
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title: The role of primary care physician and cardiologist follow-up for low-risk patients with chest pain after emergency department assessment
format: Article
creator:
  • Czarnecki, Andrew, MD
  • Wang, Julie T., MSc
  • Tu, Jack V., MD, PhD
  • Lee, Douglas S., MD, PhD
  • Schull, Michael J., MD, MSc
  • Lau, Ching, MD
  • Farkouh, Michael E., MD, MSc
  • Wijeysundera, Harindra C., MD, PhD
  • Ko, Dennis T., MD, MSc
subjects:
  • Abridged Index Medicus
  • Aged
  • Cardiology
  • Cardiovascular
  • Chest pain
  • Chest Pain - diagnosis
  • Chest Pain - etiology
  • Chest Pain - mortality
  • Chest Pain - therapy
  • Clinical outcomes
  • Continuity of Patient Care - organization & administration
  • Drug therapy
  • Emergency service
  • Emergency Service, Hospital
  • Female
  • Heart attacks
  • Hospitals
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Myocardial Infarction - epidemiology
  • Myocardial Infarction - mortality
  • Myocardial Infarction - prevention & control
  • Patients
  • Physician's Role
  • Physicians
  • Physicians, Primary Care
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
ispartof: The American heart journal, 2014, Vol.168 (3), p.289-295
description: Background Chest pain is one of the most common reasons for presentation to the emergency department (ED); however, there is a paucity of data evaluating the impact of physician follow-up and subsequent management. To evaluate the impact of physician follow-up for low-risk chest pain patients after ED assessment. Methods We performed a retrospective observational study of low-risk chest pain patients who were assessed and discharged home from an Ontario ED. Low risk was defined as ≥50 years of age and no diabetes or preexisting cardiovascular disease. Follow-up within 30 days was stratified as (a) no physician, (b) primary care physician (PCP) alone, (c) PCP with cardiologist, and (d) cardiologist alone. The primary outcome was death or myocardial infarction (MI) at 1 year. Results Among 216,527 patients, 29% had no-physician, 60% had PCP-alone, 8% had PCP with cardiologist, and 4% had cardiologist-alone follow-up after ED discharge. The mean age of the study cohort was 64.2 years, and 42% of the patients were male. After adjusting for important differences in baseline characteristics between physician follow-up groups, the adjusted hazard ratios for death or MI were 1.07 (95% CI 1.00-1.14) for the PCP group, 0.81 (95% CI 0.72-0.91) for the PCP with cardiologist group, and 0.87 (95% CI 0.74-1.02) for the cardiologist alone group, as compared with patients who had no follow-up. Conclusion In this cohort of low-risk patients who presented to an ED with chest pain, follow-up with a PCP and cardiologist was associated with significantly reduced risk of death or MI at 1 year.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0002-8703
fulltext: fulltext
issn:
  • 0002-8703
  • 1097-6744
url: Link


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titleThe role of primary care physician and cardiologist follow-up for low-risk patients with chest pain after emergency department assessment
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creatorCzarnecki, Andrew, MD ; Wang, Julie T., MSc ; Tu, Jack V., MD, PhD ; Lee, Douglas S., MD, PhD ; Schull, Michael J., MD, MSc ; Lau, Ching, MD ; Farkouh, Michael E., MD, MSc ; Wijeysundera, Harindra C., MD, PhD ; Ko, Dennis T., MD, MSc
creatorcontribCzarnecki, Andrew, MD ; Wang, Julie T., MSc ; Tu, Jack V., MD, PhD ; Lee, Douglas S., MD, PhD ; Schull, Michael J., MD, MSc ; Lau, Ching, MD ; Farkouh, Michael E., MD, MSc ; Wijeysundera, Harindra C., MD, PhD ; Ko, Dennis T., MD, MSc
descriptionBackground Chest pain is one of the most common reasons for presentation to the emergency department (ED); however, there is a paucity of data evaluating the impact of physician follow-up and subsequent management. To evaluate the impact of physician follow-up for low-risk chest pain patients after ED assessment. Methods We performed a retrospective observational study of low-risk chest pain patients who were assessed and discharged home from an Ontario ED. Low risk was defined as ≥50 years of age and no diabetes or preexisting cardiovascular disease. Follow-up within 30 days was stratified as (a) no physician, (b) primary care physician (PCP) alone, (c) PCP with cardiologist, and (d) cardiologist alone. The primary outcome was death or myocardial infarction (MI) at 1 year. Results Among 216,527 patients, 29% had no-physician, 60% had PCP-alone, 8% had PCP with cardiologist, and 4% had cardiologist-alone follow-up after ED discharge. The mean age of the study cohort was 64.2 years, and 42% of the patients were male. After adjusting for important differences in baseline characteristics between physician follow-up groups, the adjusted hazard ratios for death or MI were 1.07 (95% CI 1.00-1.14) for the PCP group, 0.81 (95% CI 0.72-0.91) for the PCP with cardiologist group, and 0.87 (95% CI 0.74-1.02) for the cardiologist alone group, as compared with patients who had no follow-up. Conclusion In this cohort of low-risk patients who presented to an ED with chest pain, follow-up with a PCP and cardiologist was associated with significantly reduced risk of death or MI at 1 year.
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subjectAbridged Index Medicus ; Aged ; Cardiology ; Cardiovascular ; Chest pain ; Chest Pain - diagnosis ; Chest Pain - etiology ; Chest Pain - mortality ; Chest Pain - therapy ; Clinical outcomes ; Continuity of Patient Care - organization & administration ; Drug therapy ; Emergency service ; Emergency Service, Hospital ; Female ; Heart attacks ; Hospitals ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction - epidemiology ; Myocardial Infarction - mortality ; Myocardial Infarction - prevention & control ; Patients ; Physician's Role ; Physicians ; Physicians, Primary Care ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment
ispartofThe American heart journal, 2014, Vol.168 (3), p.289-295
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descriptionBackground Chest pain is one of the most common reasons for presentation to the emergency department (ED); however, there is a paucity of data evaluating the impact of physician follow-up and subsequent management. To evaluate the impact of physician follow-up for low-risk chest pain patients after ED assessment. Methods We performed a retrospective observational study of low-risk chest pain patients who were assessed and discharged home from an Ontario ED. Low risk was defined as ≥50 years of age and no diabetes or preexisting cardiovascular disease. Follow-up within 30 days was stratified as (a) no physician, (b) primary care physician (PCP) alone, (c) PCP with cardiologist, and (d) cardiologist alone. The primary outcome was death or myocardial infarction (MI) at 1 year. Results Among 216,527 patients, 29% had no-physician, 60% had PCP-alone, 8% had PCP with cardiologist, and 4% had cardiologist-alone follow-up after ED discharge. The mean age of the study cohort was 64.2 years, and 42% of the patients were male. After adjusting for important differences in baseline characteristics between physician follow-up groups, the adjusted hazard ratios for death or MI were 1.07 (95% CI 1.00-1.14) for the PCP group, 0.81 (95% CI 0.72-0.91) for the PCP with cardiologist group, and 0.87 (95% CI 0.74-1.02) for the cardiologist alone group, as compared with patients who had no follow-up. Conclusion In this cohort of low-risk patients who presented to an ED with chest pain, follow-up with a PCP and cardiologist was associated with significantly reduced risk of death or MI at 1 year.
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30Retrospective Studies
31Risk Assessment
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7Chest Pain - mortality
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1Wang, Julie T., MSc
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3Lee, Douglas S., MD, PhD
4Schull, Michael J., MD, MSc
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6Farkouh, Michael E., MD, MSc
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atitleThe role of primary care physician and cardiologist follow-up for low-risk patients with chest pain after emergency department assessment
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pages289-295
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abstractBackground Chest pain is one of the most common reasons for presentation to the emergency department (ED); however, there is a paucity of data evaluating the impact of physician follow-up and subsequent management. To evaluate the impact of physician follow-up for low-risk chest pain patients after ED assessment. Methods We performed a retrospective observational study of low-risk chest pain patients who were assessed and discharged home from an Ontario ED. Low risk was defined as ≥50 years of age and no diabetes or preexisting cardiovascular disease. Follow-up within 30 days was stratified as (a) no physician, (b) primary care physician (PCP) alone, (c) PCP with cardiologist, and (d) cardiologist alone. The primary outcome was death or myocardial infarction (MI) at 1 year. Results Among 216,527 patients, 29% had no-physician, 60% had PCP-alone, 8% had PCP with cardiologist, and 4% had cardiologist-alone follow-up after ED discharge. The mean age of the study cohort was 64.2 years, and 42% of the patients were male. After adjusting for important differences in baseline characteristics between physician follow-up groups, the adjusted hazard ratios for death or MI were 1.07 (95% CI 1.00-1.14) for the PCP group, 0.81 (95% CI 0.72-0.91) for the PCP with cardiologist group, and 0.87 (95% CI 0.74-1.02) for the cardiologist alone group, as compared with patients who had no follow-up. Conclusion In this cohort of low-risk patients who presented to an ED with chest pain, follow-up with a PCP and cardiologist was associated with significantly reduced risk of death or MI at 1 year.
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pmid25173539
doi10.1016/j.ahj.2014.05.016