Sicker patients less likely to receive recommended follow-up care after ED visit for chest pain

Chest pain is one of the most common presenting symptoms encountered in emergency departments (ED) with more than 500,000 patient visits annually in Canada. In a study by researchers at the Institute for Clinical Evaluative Sciences (ICES) one in four high-risk patients assessed for chest pain and discharged from an ED in Ontario did not receive any physician follow-up within one month of discharge. Furthermore, patients with comorbidities as well as those with no primary care physicians were less likely to receive follow-up care.

“Current clinical guidelines strongly advocate for patients with chest pain discharged from the ED to receive outpatient physician follow-up for further assessment or treatment because many patients remain at risk for future events,” says Dr. Dennis Ko, lead author of the study, a senior scientist at ICES and an interventional cardiologist at the Schulich Heart Centre at Sunnybrook Health Sciences Centre.

“We have seen a significantly reduced hazard of death or myocardial infarction when a patient received follow-up care.”

The study, published today in the CMAJ, examined the clinical and non-clinical factors associated with physician follow-up among patients with chest pain after ED discharge.

The retrospective cohort study identified 56,767 patients assessed for chest pain and discharged from an ED in Ontario from April 1, 2004 to March 31, 2010. Sicker patients who had medical comorbidities and cardiac conditions such as myocardial infarction or heart failure were less likely to have follow-up. In contrast, patients who visited a primary care physician in the previous year received follow-up 6.4 times more often than those who did not.

“Instead of selecting patients with chest pain for physician follow-up based on their illness severity, we observed that system factors such as previous access to healthcare and the size of the ED were much more important in determining who received follow-up care after an ED visit.  Our observations suggest a need for a fundamental change as to how follow-up appointments should be made when patients are discharged from the ED,” says Ko.

“Factors associated with physician follow-up among chest pain patients discharged from the emergency department,” was published today in the CMAJ.

Author block: Michael K.Y. Wong; Julie T. Wang, Andrew Czarnecki,  Maria Koh,  Jack V. Tu, Michael J. Schull, Harindra C. Wijeysundera,  Ching Lau and Dennis T. Ko.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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