Chest pain is the second most common presenting complaint at the Emergency Department (ED), accounting for about 10% of all ED visits with 8-10 million annual ED visits in the US alone. The list of differential diagnoses is long, but it is commonly the perceived likelihood of acute coronary syndrome (ACS), i.e. acute myocardial infarction or unstable angina that drives management. The fear of missing cases with ACS leads to lengthy assessments in the ED and high admission rates, constituting some 25% of all medical admissions. In the end, less than 15% of all ED chest pain patients and only about 25% of admitted chest pain patients prove to have ACS, with most causes of chest pain being benign. Many of the admissions and investigations are thereby “unnecessary,” and cause a substantial health care burden. In the US alone, the cost is estimated to be 10-13 billion dollars annually.
The aim of this project is to develop new and improved management strategies for ED chest pain patients, and to test them in routine care. The new strategies are primarily created to identify a large proportion of chest pain patients suitable for safe early discharge with no need for further cardiac testing. If successful, this will reduce ED and hospital crowding, objective testing, health care costs and will benefit both patients and the health care system.