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University of Cincinnati Academic Health Center
Publish Date: 06/06/00
Media Contact: AHC Public Relations, (513) 558-4553
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Chest Pain Centers Promote Quality Care

Cincinnati--A May Annals of Emergency Medicine article written by Alan Storrow, MD, and W. Brian Gibler, MD, University of Cincinnati (UC) College of Medicine, examined the use of chest pain centers in the United States. An accompanying article in the issue recommended that all hospitals adopt multidisciplinary, coordinated programs to rapidly diagnose and treat patients with chest pain and symptoms, potentially caused by acute cardiac ischemia--the shortage of blood supply to the heart.

Storrow, assistant professor and director of the chest pain center (also known as the 'Heart ER' at The University Hospital in Cincinnati), says "these emergency department-based centers have been accepted as a safe, cost-effective, and rapid approach for the evaluation, triage, and management of patients with potential heart attacks or unstable angina." Chest pain centers were initially designed to enhance patient care by decreasing time to treatment for heart attack, and rapid identification of patients who are experiencing pain due to a decreased blood flow to the heart.

More recently, financial restraints have provided emphasis on reducing hospitalizations for those without cardiac-related problems. "The current chest pain center protocols provide rapid diagnosis and treatment of heart-related problems, while identifying those patients who can be safely discharged from the emergency department," says Storrow.

"It is not the title 'chest pain center' that counts, but the program of care in place," says Gibler, professor and chairman of the UC Department of Emergency Medicine. "However, chest pain centers can be important tools for organizing and developing the most appropriate settings for evaluating and treating patients with symptoms and signs of a severe heart attack."

According to the article by Storrow and Gibler, a national survey found chest pain centers achieved slightly shorter delays until the administration of blood-thinning medications than did emergency departments without chest pain centers (34 vs. 38 minutes). It was also noted that chest pain centers were significantly more likely to have the equipment and personnel to do extended diagnostic tests, including serial ECGs (electrocardiograms) and cardiac markers, beyond traditional clinical evaluation and the single12-lead ECGs.

The article states many patients with acute cardiac ischemia (temporary insufficiency of blood to the heart usually due to a clot or heart attack) have vague symptoms, making accurate diagnosis a clinical challenge. In approximately 2 to 4 percent of heart attack patients, the diagnosis is missed, and people are inadvertently released from the emergency department, increasing their risk of death. In addition, many treatments for cardiac problems are time dependent, and when given early, can more effectively lower death and injury rates.

"People must not delay in seeking care, and physicians must not delay in providing medical care once patients are in the emergency department," says Gibler. Treatment for acute coronary syndromes has greatly improved, but without early detection, many patients will not reap the full benefit of the innovations. "Chest pain centers are designed to rapidly diagnose cardiac problems and avoid release of sick patients, while preventing unnecessary hospitalization," adds Gibler. Each year, 4.6 million patients come to emergency departments with symptoms of a heart attack, and approximately one-fourth of them are diagnosed with acute cardiac ischemia.



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