Higher hospitalization rates for chest pain do not lead to better outcomes
Chest pain is one of the most common reasons adults in the United States visit the emergency department (ED), leading to more than 7 million patient encounters each year.
Hospital admission rates for these patients varies considerably from one ED physician to the next, with some physicians admitting an especially high number of patients and others sending a vast majority of those patients back home for rest and recuperation.
Is one strategy better than the other? Are ED hospitalization rates for chest pain directly related to patient outcomes?
A team of researchers aimed to find out, sharing its findings in Circulation: Cardiovascular Quality.
The study’s authors tracked data from more than 300 physicians within a California-based health system, focusing on patient encounters related to chest pain that occurred from January 2016 to December 2017. More than 38,000 encounters were included in the analysis. While more than 33,000 patients were discharged, more than 5,000 patients were admitted for suspected acute coronary syndrome (ACS).
The overall admission rate was 14%, but admission rates of individual physicians ranged from 1.5% to 68.9%. After certain case-mix adjustments were made, the updated range was 5.5% to 27.8%.
The key takeaway? Comparing physicians with high and low admission rates, the authors found there was no difference in 30-day mortality or acute myocardial infarction rates.
“Despite clinical care pathways aiming to safely reduce overall admissions for chest pain, our results suggest an additional opportunity to investigate the safe reduction of physician-level variation in the use of hospital care when evaluating patients with suspected ACS,” wrote lead author Shaw Natsui, MD, National Clinician Scholars Program at the University of California, Los Angeles, and colleagues.
The team did note that their work had certain limitations, including its retrospective design and the fact that patients who presented with “other atypical symptoms” associated with ACS were not included.
The study is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.