403: Frequency of Completed Outpatient Exercise Stress Testing and Physician Follow-Up In Low-Risk Acute Chest Pain Patients Presenting to a County Emergency Department

Abstract

To determine the frequency that low risk acute chest pain patients complete outpatient stress testing and physician follow-up after a 9-hour rule-out myocardial infarction (ROMI) emergency department (ED) visit. Additionally, we postulate that if patients are evaluated by cardiology during this ROMI ED visit, they will be more likely to complete follow-up care as recommended by American College of Cardiology/American Heart Association (ACC/AHA) guidelines. The IRB-approved retrospective observational study included 1147 low-risk acute chest pain patients that presented to a large county hospital ED between November 5, 2008 and April 9, 2009. Data collected from medical records of this cohort included the completion date and results of outpatient stress testing and physician follow-up dates. Comparison with data of discharged patients also receiving cardiology consultation during the ROMI ED visit will be explored in further study of this cohort. Of the 1142 patient charts reviewed, 574 (50%) underwent ROMI protocols in the ED and were discharged home without specialty consultation or hospital admission. Of these 574 patients, 180 (31%) had established appointment dates for exercise stress testing with 79/180 (44%) “no shows” and 13/180 (8%) otherwise cancelled. Of these 574 patients, 219 (38%) had established physician follow-up appointments with 24/219 (11%) “no shows” and 18/219 (8%) otherwise cancelled. Of these 574 patients, 88 (15%) completed outpatient stress testing within 7.3 +− 6.6 days after ED discharge, with 30 (5%) of these patients testing within the ACC/AHA recommended 72 hours of ED discharge. Ten of 88 (11%) demonstrated evidence of inducible ischemia, 12/88 (14%) were inconclusive, and 66/88 (75%) had no evidence of inducible ischemia. Of these 574 patients, 95 (17%) completed physician follow-up within 21 days of ED discharge. There is a low frequency of outpatient stress testing completion and physician follow-up in this cohort following 9-hour ROMI ED visits. Furthermore, there is an even lower frequency of those that complete testing within the ACC/AHA guidelines of 72 hours after ED evaluation. Continuing analysis will determine the impact of cardiology consultation to the ED on completion of recommended care, as well as the impact of a recent addition of an ED observation unit.