Acute ischemic syndromes. Chest pain center concept.
CPCs have been developed to meet the clinical challenge posed by the diverse group of patients presenting to the ED with findings suggestive of a coronary event. Using a protocol-driven approach, high- and low-risk patients can be identified on presentation, facilitating urgent therapy in the former and triage of the latter to more deliberate management. Most CPCs focus on low-risk patients who are being increasingly managed by accelerated diagnostic protocols. These methods comprise systematic strategies that include innovative diagnostic approaches during a 6 to 12 hour period of observation with serial ECGs, continuous monitoring and cardiac biomarker measurements. A negative evaluation is usually followed by predischarge stress testing, and positive findings mandate admission. An essential aspect of the CPC strategy is continuity of care for patients with negative cardiac evaluations. Current data indicate that management of low-risk patients with chest pain in a CPC is safe accurate, and appears to be cost-effective.
Amsterdam
Ezra A
EA
Divisions of Cardiovascular Medicine, University of California, Davis, Medical Center, Sacramento, California, USA. eaamsterdam@ucdavis.edu
Lewis
William R
WR
Kirk
J Douglas
JD
Diercks
Deborah B
DB
Turnipseed
Samuel
S
D000465:Algorithms; D002637:Chest Pain / Q000175:diagnosis* / Q000628:therapy*; D002983:Clinical Competence; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000628:therapy*; D018710:Pain Clinics / Q000458:organization & administration*; D010348:Patient Care Team; D014218:Triage