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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

Czarnecki A, Wang JT, Tu JV, Lee DS, Schull MJ, Lau C, Farkouh ME, Wijeysundera HC, Ko DT. Am Heart J. 2014; 168(3):289-95. Epub 2014 Jun 9.

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 — The authors 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 pre-existing 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 one-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 to 1.14) for the PCP group, 0.81 (95% CI, 0.72 to 0.91) for the PCP with cardiologist group, and 0.87 (95% CI, 0.74 to 1.02) for the cardiologist alone group, as compared to 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 one-year.

Keywords: Cardiovascular diseases Emergency department discharge Health care evaluation Treatment outcomes