title: The role of primary care physician and cardiologist follow-up for low-risk patients with chest pain after emergency department assessment.
abstract: BACKGROUND
  Chest pain is one of the most common reasons for presentation to the emergency department (ED); however, there is a paucity of data evaluating the impact of physician follow-up and subsequent management. To evaluate the impact of physician follow-up for low-risk chest pain patients after ED assessment.
  
  
  METHODS
  We performed a retrospective observational study of low-risk chest pain patients who were assessed and discharged home from an Ontario ED. Low risk was defined as ≥50 years of age and no diabetes or preexisting cardiovascular disease. Follow-up within 30 days was stratified as (a) no physician, (b) primary care physician (PCP) alone, (c) PCP with cardiologist, and (d) cardiologist alone. The primary outcome was death or myocardial infarction (MI) at 1 year.
  
  
  RESULTS
  Among 216,527 patients, 29% had no-physician, 60% had PCP-alone, 8% had PCP with cardiologist, and 4% had cardiologist-alone follow-up after ED discharge. The mean age of the study cohort was 64.2 years, and 42% of the patients were male. After adjusting for important differences in baseline characteristics between physician follow-up groups, the adjusted hazard ratios for death or MI were 1.07 (95% CI 1.00-1.14) for the PCP group, 0.81 (95% CI 0.72-0.91) for the PCP with cardiologist group, and 0.87 (95% CI 0.74-1.02) for the cardiologist alone group, as compared with patients who had no follow-up.
  
  
  CONCLUSIONS
  In this cohort of low-risk patients who presented to an ED with chest pain, follow-up with a PCP and cardiologist was associated with significantly reduced risk of death or MI at 1 year.
authors.affiliation: Schulich Heart Centre, Division of Cardiology, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Czarnecki
authors.affiliation: Institute of Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario, Canada.
authors.forename: Julie T
authors.initials: JT
authors.lastname: Wang
authors.affiliation: Schulich Heart Centre, Division of Cardiology, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario, Canada.
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.affiliation: Institute of Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Division of Cardiology, University of Toronto, University Health Network, 585 University Ave, Toronto, Ontario, Canada.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Institute of Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario, Canada; Division of Emergency Medicine, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schull
authors.affiliation: Schulich Heart Centre, Division of Cardiology, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada.
authors.forename: Ching
authors.initials: C
authors.lastname: Lau
authors.affiliation: Peter Munk Cardiac Centre, Division of Cardiology, University of Toronto, University Health Network, 585 University Ave, Toronto, Ontario, Canada.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.affiliation: Schulich Heart Centre, Division of Cardiology, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario, Canada.
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.affiliation: Schulich Heart Centre, Division of Cardiology, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario, Canada. Electronic address: dennis.ko@ices.on.ca.
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
mesh_terms: D000368:Aged; D002309:Cardiology; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D010819:Physician's Role; D058007:Physicians, Primary Care; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment