BMJ  2004;329:173 (17 July), doi:10.1136/bmj.329.7458.173

Letter

Discharge rates for suspected acute coronary syndromes

Clinical assessment tools need improving

The first 100% of the full text of this article appears below.

EDITOR—Murphy et al show some interesting trends in hospital discharge rates from 1990 to 2000 by age: a decline in discharge rates for acute myocardial infarction and rising trends for chest pain and angina.¹ I agree with their conclusion, that these trends press the need for expansion of coronary services.

The rise in chest pain rates needs careful evaluation as this might represent a trend in queue jumping in overcrowded hospitals. A recent study in two urban cardiac referral centres in Canada has reported a 5% false negative rate for emergency room clinical assessment regarding acute coronary syndrome.² Therefore, in view of the seriousness of this symptom and high associated costs of thorough cardiac evaluation, a need exists for improvement in the clinical assessment tools.

Hospital for Sick Children, University of Toronto, 555 University Avenue # 8259, Canada M5G 1X8 doc.sharieff@utoronto.ca

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Competing interests: None declared.

1. Murphy NF, MacIntyre K, Capewell S, Stewart S, Pell J, Chalmers J, et al. Hospital discharge rates for suspected acute coronary syndromes between 1990 and 2000: population based analysis. BMJ 2004;328: 1413-4. (12 June.)[Free Full Text]
2. Christenson J, Innes G, McKnight D, Boychuk B, Grafstein E, Thompson C, et al. Safety and efficiency of emergency department assessment of chest discomfort. CMAJ 2004;170: 1803-7.[Abstract/Free Full Text]

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Relevant Article

Hospital discharge rates for suspected acute coronary syndromes between 1990 and 2000: population based analysis

N F Murphy, K MacIntyre, S Capewell, S Stewart, J Pell, J Chalmers, A Redpath, S Frame, J Boyd, and J J V McMurray
BMJ 2004 328: 1413-1414. [Extract] [Full Text] [PDF]

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