Clinical Care Delivery in Chest Pain Patients Without an Acute Coronary Syndrome—A Retrospective Cohort Study

Introduction Chest pain is a common complaint among emergency department patients (ED), and various diagnostic tests have been developed to enhance the accuracy and efficiency of identifying the underlying causes of chest pain. However, healthcare systems might not adhere to the guideline-validated clinical pathways and instead order repeat diagnostic testing, resulting in patient disposition delays and increased healthcare costs. This study evaluated the efficiency and effectiveness of care delivered to chest pain patients in our tertiary medical center. Methods We performed a retrospective chart review of patients presenting to our ED with acute chest pain between November and December 2022, collecting information about patients' acute chest pain, the testing they received, and their outcomes. The data was then reviewed to determine clinical practice patterns in this cohort of patients. Results 342 patients were included according to the study criteria, with a mean age of 54 years; 54.7% of study participants were females. Patients who were eventually admitted from the ED were (46.5%, n=159), either under observation or inpatient status. Furthermore, 16.6% n=57 of patients had an ischemic evaluation within the preceding year. Physicians documented a HEART score in 24.6%, n=84 of the patients. While HEART score is a considerable factor utilized by admitting physicians to triage incoming patients, (39%, n=62) of all admitted patients had a low HEART score (< 3) and a negative ischemic evaluation within the past year. Admitted patients who underwent an inpatient ischemic workup were 51.6 %, n=82, including stress testing, the most commonly used modality (69.5%, n=58). Patients who underwent stress testing with a normal result were 98%. n=56. Conclusion The study demonstrated that the HEART score was documented in only ¼ of patients admitted from the emergency room with chest pain. Besides, ischemic testing was often repeated despite recent testing within the past year. It also found that inpatient non-invasive ischemic testing in non-ACS chest pain patients is typically negative and thus would be unlikely to change their clinical course.