Barriers to outpatient stress testing follow-up for low-risk chest pain patients presenting to an ED chest pain unit

Abstract

IntroductionOutpatient stress testing (OST) after evaluation in the emergency department (ED) is an acceptable evaluation method for patients presenting to the ED with low-risk chest pain (CP). However, not all patients return for OST. Barriers to follow-up evaluation exist and are poorly understood. In this study, we examined the influence of demographic and social characteristics on OST compliance. MethodsData were collected on low-risk CP patients with scheduled OSTs. OST compliance was assessed and then analyzed for correlation with potential barriers including insurance type; age; sex; race; employment status; the distance the patient lived from the hospital; whether or not the patient had a primary care physician; whether or not the patient had a history of hypertension or diabetes; and whether or not the patient had a history of tobacco, alcohol, or illicit drug use. ResultsA total of 275 patients were enrolled over a 5-month period. These patients had an OST follow-up rate of 61.82% within 72hours of discharge from the ED. Patients with Medicaid were statistically less likely (odds ratio [OR], 0.439) to complete OST. Patients with commercial insurance (OR, 1.8225), who were employed (OR, 2.299), or who were retired (OR, 3.44) were more likely to complete OST. All of the other variables analyzed were not statistically significant factors in OST compliance. ConclusionMore than one-third of low-risk CP patients do not follow-up with scheduled OST. Of the variables analyzed, both employment status and insurance type were statistically significant and should be included in risk stratification strategies for OST.