title: Effect on quality of life of different accelerated diagnostic protocols for management of patients presenting to the emergency department with acute chest pain.
abstract: This study assessed the effects on quality of life (QoL) of dobutamine-atropine stress echocardiography (DASE) and electrocardiogram exercise testing (EET) accelerated diagnostic protocols for early stratification of low-risk patients with acute chest pain (ACP). A total of 290 patients with ACP, a nondiagnostic electrocardiogram, and negative biomarkers were randomly assigned to an accelerated diagnostic protocol (DASE, n = 110, or EET, n = 89) or usual care (n = 91) and followed up for 2 months. QoL was assessed at discharge and 2-month follow-up using the Nottingham Health Profile questionnaire. Baseline and 2-month follow-up answers to the Nottingham Health Profile questionnaire were available for 207 patients (71%; 55 in the usual-care, 77 in the DASE, and 75 in the ETT arm). At predischarge, patients in the usual-care arm reported higher impairment in the physical mobility and pain dimensions compared with the DASE and EET arms (p = 0.019 and p = 0.023, respectively). At 2-month follow-up, QoL improved in all groups; however, patients in the usual-care arm had significantly worse scores than patients managed using accelerated diagnostic protocols in the physical mobility, pain, social isolation, emotional reactions, and energy level dimensions (p = 0.014, p = 0.002, p = 0.04, p = 0.01, and p = 0.003, respectively). In conclusion, low-risk patients with ACP had non-negligible impairment of QoL in the acute phase. Emergency department ADPs with early DASE and EET reduced QoL impairment at both baseline and 2-month follow-up.
authors.affiliation: Istituto per la Ricerca Clinica Applicata e di Base Foundation, Udine, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Nucifora
authors.forename: Luigi P
authors.initials: LP
authors.lastname: Badano
authors.forename: Nizal
authors.initials: N
authors.lastname: Sarraf-Zadegan
authors.forename: Apostolos
authors.initials: A
authors.lastname: Karavidas
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trocino
authors.forename: Giorgio
authors.initials: G
authors.lastname: Scaffidi
authors.forename: Giacinto
authors.initials: G
authors.lastname: Pettinati
authors.forename: Costantino
authors.initials: C
authors.lastname: Astarita
authors.forename: Vitas
authors.initials: V
authors.lastname: Vysniauskas
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
authors.forename: Baris
authors.initials: B
authors.lastname: Ilerigelen
authors.forename: Paolo M
authors.initials: PM
authors.lastname: Fioretti
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D002637:Chest Pain / Q000209:etiology*; D025401:Echocardiography, Stress; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D006801:Humans; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011788:Quality of Life; D018570:Risk Assessment; D011795:Surveys and Questionnaires