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Evaluation of stable chest pain following emergency department presentation: Impact of first‐line cardiac computed tomography diagnostic strategy in an Australian setting.
- Source :
- Emergency Medicine Australasia; Feb2024, Vol. 36 Issue 1, p31-38, 8p
- Publication Year :
- 2024
-
Abstract
- Objective: International guidelines provide increasing support for computed tomography coronary angiography (CTCA) in investigating chest pain. A pathway utilising CTCA first‐line for outpatient stable chest pain evaluation was implemented in an Australian ED. Methods: In pre‐post design, the impact of the pathway was prospectively assessed over 6 months (August 2021 to January 2022) and compared with a 6‐month pre‐implementation group (February 2021 to July 2021). CTCA was recommended first‐line in suspected stable cardiac chest pain, followed by chest pain clinic review. Predefined criteria were provided recommending functional testing in select patients. The impact of CTCA versus functional testing was evaluated. Data were obtained from digital medical records. Results: Three hundred and fifteen patients were included, 143 pre‐implementation and 172 post‐implementation. Characteristics were similar except age (pre‐implementation: 58.9 ± 12.0 vs post‐implementation: 62.8 ± 12.3 years, P = 0.004). Pathway‐guided management resulted in higher first‐line CTCA (73.3% vs 46.2%, P < 0.001), lower functional testing (30.2% vs 56.6%, P < 0.001) and lower proportion undergoing two non‐invasive tests (4.7% vs 10.5%, P = 0.047), without increasing investigation costs or invasive coronary angiography (ICA) (pre‐implementation: 13.3% vs post‐implementation: 9.3%, P = 0.263). In patients undergoing CTCA, 40.7% had normal coronaries and 36.2% minimal/mild disease, with no difference in disease burden post‐implementation. More medication changes occurred following CTCA compared with functional testing (aspirin: P = 0.005, statin: P < 0.001). In patients undergoing ICA, revascularisation to ICA ratio was higher following CTCA compared with functional testing (91.7% vs 18.2%, P < 0.001). No 30‐day myocardial infarction or death occurred. Conclusions: The pathway increased CTCA utilisation and reduced downstream investigations. CTCA was associated with medication changes and improved ICA efficiency. [ABSTRACT FROM AUTHOR]
- Subjects :
- CHEST pain diagnosis
BLOOD vessels
HOSPITAL emergency services
SCIENTIFIC observation
MANN Whitney U Test
FISHER exact test
CORONARY angiography
T-test (Statistics)
PEARSON correlation (Statistics)
PRE-tests & post-tests
RESEARCH funding
DESCRIPTIVE statistics
CHI-squared test
HEALTH care teams
COMPUTED tomography
DATA analysis software
OUTPATIENTS
Subjects
Details
- Language :
- English
- ISSN :
- 17426731
- Volume :
- 36
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Emergency Medicine Australasia
- Publication Type :
- Academic Journal
- Accession number :
- 174818039
- Full Text :
- https://doi.org/10.1111/1742-6723.14290