Chest pain patients educated about risk more likely to opt out of stress test

Chest pain patients educated about their future heart attack risk and involved in deciding care options were more likely than less-aware patients to opt out of stress testing, according to research in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

Chest pain, the second most common reason people seek emergency care at U.S. hospitals, accounts for 8 million patient visits and about $8 billion in annually, researchers said.

"To avoid missing a diagnosis of heart attack, emergency physicians often admit patients to observation units for stress testing, even though patients are at a very low risk for heart attack," said Erik P. Hess, M.D., M.Sc., lead author of the study and emergency room (ER) consultant at the Mayo Clinic in Rochester, Minn. "This results in false positive test results, unnecessary additional procedures, exposure to radiation and increased cost."

Hess and colleagues, investigating how care might change if patients were more educated about their health care, designed a decision aid (visual patient-education tool) about care options and 45-day risk of a heart attack.

Then, they studied 204 emergency department patients being considered for stress testing. Half the patients received the decision aid and half didn't.

After conducting surveys immediately after the ER visit to test patients' knowledge and analyze involvement in decision-making, researchers found:

  • Decision-aid patients decided to be admitted to the observation unit for stress testing 58 percent of the time compared to 77 percent for patients in the traditional care group.
  • Patients in the decision-aid group were much more knowledgeable about their and options than those in the traditional care group.
  • The degree of involvement in care decisions in patients who received the decision aid was four times greater than those who didn't receive the decision aid.
  • Patients in the decision-aid group said the information was clear and helpful, and three of four surveyed said they would recommend it to others.
  • No major adverse heart problems occurred within 30 days of discharge in either group.
"This study suggests that low-risk patients don't necessarily want extensive testing once a has been ruled out," Hess said. "Informing patients of their risk and engaging them in the decision-making process may enable physicians and patients to work together to choose an approach to evaluation that is more in line with what patients want, without negatively affecting the results of their health care."

To confirm results of this study conducted in one hospital, Hess said researchers should test the decision aid in many different emergency departments.

"Use of the decision aid requires close collaboration between emergency physicians and cardiologists so can receive follow-up care 24 to 72 hours after they leave the emergency room," Hess said. "So, the use of the decision aid will be more difficult in healthcare settings with less reliable access to outpatient follow-up."

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Most seniors eligible for statin Rx under new guidelines

Nov 25, 2014

(HealthDay)—Most older Americans qualify for treatment with statins under new guidelines for the treatment of blood cholesterol released late last year by the American College of Cardiology and the American ...

Asymptomatic atherosclerosis linked to cognitive impairment

Nov 25, 2014

In a study of nearly 2,000 adults, researchers found that a buildup of plaque in the body's major arteries was associated with mild cognitive impairment. Results of the study conducted at the University of Texas (UT) Southwestern ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.