Intended for healthcare professionals


“Chest pain—please admit”: is there an alternative?

BMJ 2000; 320 doi: (Published 08 April 2000) Cite this as: BMJ 2000;320:951

A rapid cardiological assessment service may prevent unnecessary admissions

  1. Simon Capewell, professor of clinical epidemiology,
  2. John McMurray, professor of cardiology
  1. Department of Public Health, University of Liverpool, Liverpool L69 3GB
  2. Glasgow Western Infirmary, University of Glasgow G12 8QQ

    Emergency medical admissions are important. They continue to rise year after year; consume substantial NHS resources; disrupt other NHS activities; and generate winter bed crises.1 2 Patients with acute central chest pain account for 20-30% of emergency medical admissions.3 4 Most are admitted because of concern about unstable coronary heart disease. Yet fewer than half will have a final diagnosis of acute myocardial infarction or unstable angina.4 Patients without high risk coronary heart disease thus account for over half those presenting with chest pain and over 10% of all emergency medical admissions. Such patients could be safely managed without admission, and most would prefer it. The current system is therefore both ineffective and inefficient. Any scheme which safely avoided these unnecessary admissions might save resources, reduce stress for patients, and, crucially, reduce the worrying false negatives—those missed cases of high risk coronary heart disease. …

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