Chest Pain Choice - Chest Pain Choice

Apr 03, 2016
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Author/Summarized by Author:
Dharam J. Kumbhani, MD, SM, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Date Presented:
04/03/2016
Original Posted Date:
04/03/2016
References

Description:

The goal of the trial was to compare the impact of a decision aid on patient knowledge and satisfaction among those presenting to the emergency department (ED) with low-risk chest pain.

Contribution to the Literature: This study suggests that the use of a shared decision making aid among patients who presented to the ED with low-risk chest pain increased patient knowledge and satisfaction and also reduced resource utilization, with low overall rates of adverse events.



Study Design

Patients were randomized in a 1:1 fashion to either use of a tailored decision aid (n = 447) or routine care (n = 451).

  • Total number of enrollees: 898
  • Duration of follow-up: 30 days
  • Mean patient age: 50 years
  • Percentage female: 57%

Other salient features/characteristics:

  • Pretest probability of acute coronary syndrome: 3.7%

Inclusion criteria:

  • Adults with chest pain considered for ED outpatient unit admission for stress testing or coronary computed tomography angiography (CTA)

Exclusion criteria:

  • Ischemic electrocardiogram
  • Elevated troponin
  • Known coronary artery disease
  • Cocaine use within 72 hours
  • Unable to provide informed consent or use decision aid

Principal Findings:

Primary outcome, patient knowledge for decision aid use vs. routine care: 4.23 vs. 3.56, p < 0.001

Secondary outcomes (decision aid vs. routine care):

  • Patient engagement on OPTION scale: 18 vs. 8, p < 0.001
  • Both patients and physicians reported that they would recommend the aid to someone else (p < 0.001), and patients also felt that clarity of information was higher (p = 0.01)
  • Major adverse cardiac events at 30 days: 0% vs. 0%, p = 1.0
  • Revascularization: 2% vs. 1%, p = 0.37
  • Myocardial infarction: 1% vs. 0%, p = 1.0
  • Admitted to ED outpatient unit for stress test or coronary CT: 37% vs. 52%, p < 0.001
  • Stress testing within 30 days: 38% vs. 46%, p = 0.013

Interpretation:

The results of this trial indicate that the use of a shared decision making aid among patients who presented to the ED with low-risk chest pain increased patient knowledge and satisfaction and also reduced resource utilization. Event rates were low, but the trial was not powered to study clinical differences between the two groups. Shared decision making for cardiovascular care is a new, but growing field of research.

References:

Presented by Dr. Erik P. Hess at the American College of Cardiology Annual Scientific Session, Chicago, IL, April 3, 2016.

Keywords: ACC Annual Scientific Session, Acute Coronary Syndrome, Chest Pain, Angiography, Decision Support Techniques, Emergency Service, Hospital, Exercise Test, Myocardial Infarction, Personal Satisfaction, Tomography, Tomography, Emission-Computed


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