A clinical practice audit of management and outcomes of patients presenting with chest pain to the Medical Admissions Unit

Abstract

Acute central chest pain accounts for a significant proportion of emergency medical admissions. If chest pain evaluation is systematic & risk-based, it may prevent unnecessary admissions. This audit aims to observe various aspects of management of patients admitted with chest pain; areas needing review are identified and improvements on current practice are considered. The study observed the current practices in 292 admissions for chest pain to the Medical Admissions Unit over a 3 month period. The relative frequency of risk factors and utilisation of resources were observed. Ninety-one patients (31.2%) that were admitted with chest pain had a diagnostic ECG or raised cardiac enzymes. Twenty-one patients (7.2%) had an urgent exercise stress test (EST) whilst 27 patients (9.2%) had an urgent coronary angiogram. In all, 16 patients (5.5 %) were readmitted with a cardiac event and 8 patients (2.7%) died within 3 months. The presence of age >65, diabetes or hypertension were associated with a high rate of adverse events (13.9%, 16.4%, and 11.6% respectively).