The Chest Pain Choice Decision Aid: A Randomized Trial

Study Questions:

What is the impact of a decision aid on the knowledge and engagement in decision making in patients with chest pain?


The authors randomized 204 patients presenting with chest pain to a decision aid or usual care and followed them for 30 days. The decision aid included a 100-person pictograph depicting the pretest probability of acute coronary syndrome and available management options (observation unit admission and stress testing or 24-72 hours of outpatient follow-up). The primary outcome was patient knowledge measured by an immediate postvisit survey.


Of the total cohort, 103 were randomized to usual care and 101 to the decision aid group. Patients in the decision aid arm had significantly greater knowledge (3.6 vs. 3.0 questions correct; mean difference, 0.67; 95% confidence interval, 0.34-1.0), were more engaged in decision making as indicated by higher OPTION (observing patient involvement) scores (26.6 vs. 7.0; mean difference, 19.6; 95% confidence interval, 1.6-21.6), and decided less frequently to be admitted to the observation unit for stress testing (58% vs. 77%). There were no major adverse cardiac events after discharge in either group.


The pictographic decision tool was effective at increasing knowledge and engagement in patients presenting with acute chest pain.


The authors are to be commended for rigorously evaluating a tool that increases patient knowledge and helps facilitate informed decision making. Further, the use of the tool was associated with a decrease in resource utilization. Such tools should be considered for routine use among low-risk patients presenting with acute chest pain.

Clinical Topics: Acute Coronary Syndromes

Keywords: Acute Coronary Syndrome, Chest Pain

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