Medicine hospitalists have recognized unnecessary practices for low-risk chest pain in an article recently published in the Journal of Hospital Medicine.
(February 13, 2018) — Hospitalists Christopher Caulfield, MD and John Stephens, MD, have published an article that reviews practices for low-risk chest pain for the Journal of Hospital Medicine’s “Things We Do for No Reason” series, a regular feature in the journal that highlights commonly performed but low-value care practices in hospital medicine.
The article recognizes chest pain as one of the most common complaints among patients who come to the ED. While 30% of patients presenting with pain are admitted for observation, more than 70% undergo cardiac stress testing during hospitalization, and this testing could be exposing patients to needless risks and unnecessary care costs with little value to patients.
Caulfield from the division of hospital medicine says clinical risk prediction models can provide a better evaluation option for managing patients with chest pain.
“When patients come in with chest pain and either a dynamic electro cardiogram or an elevated troponin level, they require further acute ischemia diagnosis (ACS) and treatment,” said Caulfield. “But when ACS can’t be clearly diagnosed, we recommend that providers use clinical risk prediction models to more effectively stratify patients.”
The article provides a clinical scenario and explains how risk prediction models such as the Thrombolysis in Myocardial Infarction (TIMI) and HEART scores have been validated for evaluating patients with chest pain.
Stephens says outpatient cardiac stress testing can be reliably and safety performed for patients who present with chest pain.
“Research shows there is no clear evidence that earlier cardiac stress testing can lead to improved patient outcomes,” said Stephens. “Given the costs and harms of hospital observation, with little patient benefit, it is unnecessary to hospitalize all low-risk patients.”
Caulfield and Stephens offer five recommendations for patients who present with low-risk chest pain. To read the article, visit Things We Do for No Reason.
The idea of choosing wisely comes from the American Board of Internal Medicine‘s initiative to encourage national and active discussion on unnecessary medical tests, treatments and procedures.