title: Long-term mortality of chest pain patients managed according to a decision scheme that aims to avoid inappropriate hospitalisations.
abstract: OBJECTIVE
  A triage decision scheme was developed to avoid unnecessary hospitalisations for suspected acute coronary syndromes. The current investigation aimed at evaluating the long-term survival of patients who were managed according to this scheme.
  
  
  METHODS
  Patients (n=964) with symptoms suggestive of acute cardiac pathology, who were seen by a general practitioner, and for whom a pre-hospital ECG was recorded by the ambulance service in 1993-1994.
  
  
  METHODS
  During the year 2000 a follow-up of the entire cohort was performed, and the vital status of patients was determined via the civil registry office. Cox's multivariable regression analyses were performed to evaluate the relation between final (hospital discharge) diagnosis and long-term outcome.
  
  
  RESULTS
  The median follow-up was 6.0 years (4.6-6.6). Six-year mortality of the entire cohort was 30%. Long-term mortality was significantly lower in patients identified to be at low risk, who are not hospitalised, than in hospitalised patients (six-year mortality 7.5% versus 33.1%; p<0.0001). Longterm outcome was strongly associated with the final hospital discharge diagnosis.
  
  
  CONCLUSIONS
  Our data support the usefulness and appropriateness of the applied diagnostic scheme that aims to avoid unjustified hospital and CCU admissions in patients with acute chest pain.
authors.forename: A
authors.initials: A
authors.lastname: de Torbal
authors.forename: E W M
authors.initials: EW
authors.lastname: Grijseels
authors.forename: R T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: J A M
authors.initials: JA
authors.lastname: Hartman
authors.forename: M L
authors.initials: ML
authors.lastname: Simoons
authors.forename: E
authors.initials: E
authors.lastname: Boersma
keywords: acute coronary syndromes; long-term mortality