Chest pain units: A necessity or only a name to encourage patients.
BACKGROUND
Acute chest pain is a common symptom among patients presenting to emergency wards. Identification and admission of patients with real acute coronary syndrome and preventing the hospitalization of people with false diagnosis of coronary syndrome are the most important tasks in emergency wards. The purpose of this study was to investigate the usefulness of designing a special chest pain unit in emergency department of Imam Khomeini Hospital (Ahvaz, Iran).


METHODS
The patients with markers of ongoing cardiac ischemia underwent selective coronary angiography. The chest pain unit protocol was applied to selected patients with no definite evidence of acute coronary syndrome or alternative pathology. The protocol consisted of twelve hours of observation and serial 12-lead electrocardiography, transthoracic echocardiography, and biochemical testing followed by an exercise treadmill test. We compared the number of patients who were discharged after work up, discharged themselves against medical advice, admitted at coronary care unit (CCU), underwent invasive procedures or died between 2007 and 2010.


RESULTS
During 2010, 43% of patients were discharged after evaluation in the chest pain unit. In 2007 however, 26% were discharged following traditional assessments. The admission rate increased from 23% in 2007 to 36% in 2010. The percentage of patients who discharged themselves against medical advice decreased from 37% in 2007 to 14% in 2010. There was not a statistically significant difference between mortality rates in 2007 and 2010.


CONCLUSIONS
Providing a special chest pain unit in emergency ward in our condition is helpful. It reduces unnecessary admissions and improves patient satisfaction.
Assistant Professor, Department of Cardiology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Ahmad
A
Reza Assareh
Nasim
N
Azadi
Safar Ali
SA
Tahmasebi
Tooba
T
Sahraei
Razieh
R
Dabbagh
Ebrahim
E
Hajizadeh
Kamran
K
Mahdavi
Ali
A
Heydari
Mohammad
M
Alasti
Acute Coronary Syndrome; Chest Pain Unit; Myocardial Infarction