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 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.