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Outcomes in patients with chest pain evaluated in a chest pain unit: The Chest Pain Evaluation in the Emergency Room study cohort

Background Limited data exist on the long-term outcomes of patients who undergo evaluation in a chest pain unit (CPU). Methods Our study included patients with chest pain at intermediate risk for acute cardiovascular events enrolled in the CHEER study. The primary outcome included a composite of dea... Full description

Journal Title: The American heart journal 2011, Vol.161 (5), p.871-877
Main Author: Cullen, Michael W., MD
Other Authors: Reeder, Guy S., MD , Farkouh, Michael E., MD, MSc , Kopecky, Stephen L., MD , Smars, Peter A., MD , Behrenbeck, Thomas R., MD, PhD , Allison, Thomas G., PhD, MPH
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: New York, NY: Mosby, Inc
ID: ISSN: 0002-8703
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title: Outcomes in patients with chest pain evaluated in a chest pain unit: The Chest Pain Evaluation in the Emergency Room study cohort
format: Article
creator:
  • Cullen, Michael W., MD
  • Reeder, Guy S., MD
  • Farkouh, Michael E., MD, MSc
  • Kopecky, Stephen L., MD
  • Smars, Peter A., MD
  • Behrenbeck, Thomas R., MD, PhD
  • Allison, Thomas G., PhD, MPH
subjects:
  • Abridged Index Medicus
  • Acute coronary syndromes
  • Analysis
  • Angina, Unstable - complications
  • Angina, Unstable - epidemiology
  • Angina, Unstable - physiopathology
  • Biological and medical sciences
  • Cardiology. Vascular system
  • Cardiovascular
  • Cardiovascular disease
  • Chest pain
  • Chest Pain - epidemiology
  • Chest Pain - etiology
  • Chest Pain - therapy
  • Coronary Care Units - methods
  • Diagnosis, Differential
  • Disease Progression
  • Electrocardiography
  • Emergency medical care
  • Emergency service
  • Female
  • Fitness equipment
  • Follow-Up Studies
  • Heart attacks
  • Heart failure
  • Hospitalization
  • Hospitals
  • Humans
  • Incidence
  • Length of Stay
  • Male
  • Medical prognosis
  • Medical sciences
  • Middle Aged
  • Minnesota - epidemiology
  • Myocardial Infarction - complications
  • Myocardial Infarction - epidemiology
  • Myocardial Infarction - physiopathology
  • Patient Admission
  • Patient outcomes
  • Prognosis
  • Statistical analysis
  • Stroke
  • Studies
  • Surveillance
  • Survival analysis
  • Survival Rate - trends
ispartof: The American heart journal, 2011, Vol.161 (5), p.871-877
description: Background Limited data exist on the long-term outcomes of patients who undergo evaluation in a chest pain unit (CPU). Methods Our study included patients with chest pain at intermediate risk for acute cardiovascular events enrolled in the CHEER study. The primary outcome included a composite of death, myocardial infarction, acute heart failure, stroke, and out-of-hospital cardiac arrest. The secondary outcome included a composite of cardiovascular death, myocardial infarction, acute heart failure, stroke, revascularization, and unstable angina. Data were obtained through a medical record review. We compared outcomes between groups randomized to the CPU versus admission, those admitted from the CPU versus dismissed home, and those who were admitted versus dismissed home after a cardiac stress test in the emergency department. Results The final analysis included 407 patients. Median surveillance length was 5.5 years. No differences in the primary outcome or secondary outcome existed between patients randomized to the CPU versus admitted to hospital (21.6% vs 20.2% and 29.9% vs 33.0%, respectively, P > .05 for all comparisons). Patients admitted from the CPU had higher rates of the secondary outcome (adjusted hazard ratio 2.26) than patients dismissed from the CPU. Patients admitted after a cardiac stress test in the CPU had higher rates of the secondary outcome (adjusted hazard ratio 2.42) than patients dismissed from the CPU. Conclusions A CPU does not increase long-term adverse outcomes in patients with chest pain at intermediate risk for an acute event.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0002-8703
fulltext: fulltext
issn:
  • 0002-8703
  • 1097-6744
url: Link


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titleOutcomes in patients with chest pain evaluated in a chest pain unit: The Chest Pain Evaluation in the Emergency Room study cohort
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creatorCullen, Michael W., MD ; Reeder, Guy S., MD ; Farkouh, Michael E., MD, MSc ; Kopecky, Stephen L., MD ; Smars, Peter A., MD ; Behrenbeck, Thomas R., MD, PhD ; Allison, Thomas G., PhD, MPH
creatorcontribCullen, Michael W., MD ; Reeder, Guy S., MD ; Farkouh, Michael E., MD, MSc ; Kopecky, Stephen L., MD ; Smars, Peter A., MD ; Behrenbeck, Thomas R., MD, PhD ; Allison, Thomas G., PhD, MPH
descriptionBackground Limited data exist on the long-term outcomes of patients who undergo evaluation in a chest pain unit (CPU). Methods Our study included patients with chest pain at intermediate risk for acute cardiovascular events enrolled in the CHEER study. The primary outcome included a composite of death, myocardial infarction, acute heart failure, stroke, and out-of-hospital cardiac arrest. The secondary outcome included a composite of cardiovascular death, myocardial infarction, acute heart failure, stroke, revascularization, and unstable angina. Data were obtained through a medical record review. We compared outcomes between groups randomized to the CPU versus admission, those admitted from the CPU versus dismissed home, and those who were admitted versus dismissed home after a cardiac stress test in the emergency department. Results The final analysis included 407 patients. Median surveillance length was 5.5 years. No differences in the primary outcome or secondary outcome existed between patients randomized to the CPU versus admitted to hospital (21.6% vs 20.2% and 29.9% vs 33.0%, respectively, P > .05 for all comparisons). Patients admitted from the CPU had higher rates of the secondary outcome (adjusted hazard ratio 2.26) than patients dismissed from the CPU. Patients admitted after a cardiac stress test in the CPU had higher rates of the secondary outcome (adjusted hazard ratio 2.42) than patients dismissed from the CPU. Conclusions A CPU does not increase long-term adverse outcomes in patients with chest pain at intermediate risk for an acute event.
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languageeng
publisherNew York, NY: Mosby, Inc
subjectAbridged Index Medicus ; Acute coronary syndromes ; Analysis ; Angina, Unstable - complications ; Angina, Unstable - epidemiology ; Angina, Unstable - physiopathology ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Chest pain ; Chest Pain - epidemiology ; Chest Pain - etiology ; Chest Pain - therapy ; Coronary Care Units - methods ; Diagnosis, Differential ; Disease Progression ; Electrocardiography ; Emergency medical care ; Emergency service ; Female ; Fitness equipment ; Follow-Up Studies ; Heart attacks ; Heart failure ; Hospitalization ; Hospitals ; Humans ; Incidence ; Length of Stay ; Male ; Medical prognosis ; Medical sciences ; Middle Aged ; Minnesota - epidemiology ; Myocardial Infarction - complications ; Myocardial Infarction - epidemiology ; Myocardial Infarction - physiopathology ; Patient Admission ; Patient outcomes ; Prognosis ; Statistical analysis ; Stroke ; Studies ; Surveillance ; Survival analysis ; Survival Rate - trends
ispartofThe American heart journal, 2011, Vol.161 (5), p.871-877
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1Reeder, Guy S., MD
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3Kopecky, Stephen L., MD
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5Behrenbeck, Thomas R., MD, PhD
6Allison, Thomas G., PhD, MPH
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descriptionBackground Limited data exist on the long-term outcomes of patients who undergo evaluation in a chest pain unit (CPU). Methods Our study included patients with chest pain at intermediate risk for acute cardiovascular events enrolled in the CHEER study. The primary outcome included a composite of death, myocardial infarction, acute heart failure, stroke, and out-of-hospital cardiac arrest. The secondary outcome included a composite of cardiovascular death, myocardial infarction, acute heart failure, stroke, revascularization, and unstable angina. Data were obtained through a medical record review. We compared outcomes between groups randomized to the CPU versus admission, those admitted from the CPU versus dismissed home, and those who were admitted versus dismissed home after a cardiac stress test in the emergency department. Results The final analysis included 407 patients. Median surveillance length was 5.5 years. No differences in the primary outcome or secondary outcome existed between patients randomized to the CPU versus admitted to hospital (21.6% vs 20.2% and 29.9% vs 33.0%, respectively, P > .05 for all comparisons). Patients admitted from the CPU had higher rates of the secondary outcome (adjusted hazard ratio 2.26) than patients dismissed from the CPU. Patients admitted after a cardiac stress test in the CPU had higher rates of the secondary outcome (adjusted hazard ratio 2.42) than patients dismissed from the CPU. Conclusions A CPU does not increase long-term adverse outcomes in patients with chest pain at intermediate risk for an acute event.
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1Acute coronary syndromes
2Analysis
3Angina, Unstable - complications
4Angina, Unstable - epidemiology
5Angina, Unstable - physiopathology
6Biological and medical sciences
7Cardiology. Vascular system
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9Cardiovascular disease
10Chest pain
11Chest Pain - epidemiology
12Chest Pain - etiology
13Chest Pain - therapy
14Coronary Care Units - methods
15Diagnosis, Differential
16Disease Progression
17Electrocardiography
18Emergency medical care
19Emergency service
20Female
21Fitness equipment
22Follow-Up Studies
23Heart attacks
24Heart failure
25Hospitalization
26Hospitals
27Humans
28Incidence
29Length of Stay
30Male
31Medical prognosis
32Medical sciences
33Middle Aged
34Minnesota - epidemiology
35Myocardial Infarction - complications
36Myocardial Infarction - epidemiology
37Myocardial Infarction - physiopathology
38Patient Admission
39Patient outcomes
40Prognosis
41Statistical analysis
42Stroke
43Studies
44Surveillance
45Survival analysis
46Survival Rate - trends
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titleOutcomes in patients with chest pain evaluated in a chest pain unit: The Chest Pain Evaluation in the Emergency Room study cohort
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1Acute coronary syndromes
2Analysis
3Angina, Unstable - complications
4Angina, Unstable - epidemiology
5Angina, Unstable - physiopathology
6Biological and medical sciences
7Cardiology. Vascular system
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12Chest Pain - etiology
13Chest Pain - therapy
14Coronary Care Units - methods
15Diagnosis, Differential
16Disease Progression
17Electrocardiography
18Emergency medical care
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37Myocardial Infarction - physiopathology
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0Cullen, Michael W., MD
1Reeder, Guy S., MD
2Farkouh, Michael E., MD, MSc
3Kopecky, Stephen L., MD
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6Allison, Thomas G., PhD, MPH
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volume161
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pages871-877
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abstractBackground Limited data exist on the long-term outcomes of patients who undergo evaluation in a chest pain unit (CPU). Methods Our study included patients with chest pain at intermediate risk for acute cardiovascular events enrolled in the CHEER study. The primary outcome included a composite of death, myocardial infarction, acute heart failure, stroke, and out-of-hospital cardiac arrest. The secondary outcome included a composite of cardiovascular death, myocardial infarction, acute heart failure, stroke, revascularization, and unstable angina. Data were obtained through a medical record review. We compared outcomes between groups randomized to the CPU versus admission, those admitted from the CPU versus dismissed home, and those who were admitted versus dismissed home after a cardiac stress test in the emergency department. Results The final analysis included 407 patients. Median surveillance length was 5.5 years. No differences in the primary outcome or secondary outcome existed between patients randomized to the CPU versus admitted to hospital (21.6% vs 20.2% and 29.9% vs 33.0%, respectively, P > .05 for all comparisons). Patients admitted from the CPU had higher rates of the secondary outcome (adjusted hazard ratio 2.26) than patients dismissed from the CPU. Patients admitted after a cardiac stress test in the CPU had higher rates of the secondary outcome (adjusted hazard ratio 2.42) than patients dismissed from the CPU. Conclusions A CPU does not increase long-term adverse outcomes in patients with chest pain at intermediate risk for an acute event.
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doi10.1016/j.ahj.2011.02.008