title: Outcomes of patients admitted for observation of chest pain.
abstract: BACKGROUND
  Low-risk chest pain is a common cause of hospital admission; however, to our knowledge, there are no guidelines regarding the appropriate use of stress testing in such cases.
  
  
  METHODS
  We performed a retrospective cohort study of patients 21 years and older who were admitted to our tertiary care center with chest pain in 2007 and 2008. Using electronic records and chart review, we sought (1) to identify differences in the use of stress testing based on patient demographics and comorbidities, pretest probability of coronary artery disease, and house staff coverage and (2) to describe the results of stress testing and patient outcomes, including revascularization procedures and 30-day readmissions for myocardial infarction.
  
  
  RESULTS
  Of 2107 patients, 1474 (69.9%) underwent stress tests, and the results were abnormal in 184 patients (12.5%). Within 30 days, 22 patients (11.6%) with abnormal test results underwent cardiac catheterization, 9 (4.7%) underwent revascularization, and 2 (1.1%) were readmitted for myocardial infarction. In a multivariable model, stress test ordering was positively associated with age younger than 70 years (RR [relative risk], 1.12; 95% CI, 1.02-1.23), private insurance (vs Medicare/Medicaid: RR, 1.19; 95% CI, 1.11-1.27), and no house staff coverage (RR, 1.39; 95% CI, 1.28-1.50). Of patients with low (<10%) pretest probability, 68.0% underwent stress testing, but only 4.5% of these had abnormal test results.
  
  
  CONCLUSIONS
  Most patients who are admitted with low-risk chest pain undergo stress testing, regardless of pretest probability, but abnormal test results are uncommon and rarely acted on. Ordering stress tests based on pretest probability could improve efficiency without endangering patients.
authors.affiliation: Divisions of Cardiology, Baystate Medical Center, Springfield, MA 01199, USA. srikanth.penumetsa@baystatehealth.org
authors.forename: Srikanth C
authors.initials: SC
authors.lastname: Penumetsa
authors.forename: Jaya
authors.initials: J
authors.lastname: Mallidi
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Friderici
authors.forename: William
authors.initials: W
authors.lastname: Hiser
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002637:Chest Pain / Q000209:etiology*; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D016012:Poisson Distribution; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*