A small percentage of the population represents a disproportionate number of attendances at emergency departments (ED). “Frequent presenters” to ED with chest pain do not always fit into established pathways for acute myocardial events. With accelerated “rule out” protocols, patients are often discharged from the ED after short lengths of stay. This research will evaluate the effectiveness of a phone based care-coordination pilot designed to meet the needs of patients attending ED with cardiac and non-cardiac chest pain.
A longitudinal, single-arm interventional study with retrospectively recruited control group. Ninety-five patients were enrolled as the intervention group; 97 patients were retrospectively identified as controls. These patients had re-presented with chest pain within 6 months of a cardiac event, or attended hospital within 12 months two or more times with chest pain and/or complex needs. Intervention group patients were holistically assessed then phone-coached to support self-management of chest pain over 6 months. Following descriptive and univariate analysis, multivariate analysis was conducted to adjust for noted differences between the intervention and control groups.
Thirty-day representation to ED was significantly less for the intervention group (14.1%) compared to controls (27.7%). After adjusting for baseline differences, intervention patients were more than two-fold less likely to re-present compared to controls (OR = 0.42, 95%CI: 0.19–0.96). After adjustment for baseline differences, the savings in subsequent inpatient costs was $1588 per person, as a result of intervention, patients were less likely to have inpatient readmissions (16.3%) compared to controls (20.2%), although this was not statistically significant (p = 0.588).
A phone based care-coordination pilot with targeted interventions has the potential to reduce ED presentations and hospital readmissions among patients representing with chest pain.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Heart, Lung and Circulation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department.Psychology & Health. 2014; 29: 1265-1282
- The health care burden of acute chest pain.Heart. 2005; 91: 229-230
- Frequent attenders at emergency departments: a linked-data population study of adult patients.Medical Journal of Australia. 2008; 189: 552-555
- Patient related factors in frequent readmissions: the influence of condition, access to services and patient choice.BMC Health Serv Res. 2010; 10: 1-8
- Cost and outcomes of assessing patients with chest pain in an Australian emergency department.Medical Journal of Australia. 2015; 202: 427-432
- A Randomised controlled trial of a self management plan for patients with Angina.British Journal of General Practice. 2002; 52: 194-201
- Treatment Efficacy for Non-Cardiovascular Chest Pain: A Systematic Review and Meta-Analysis.PLoS ONE. 2014; 9
- National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016.Heart, Lung and Circulation. 2016; 25: 895-951
- Factors influencing the decision to seek treatment for symptoms of acute myocardial infarction: An evaluation of the Self–Regulatory Model of illness behavior.Journal of Psychosomatic Research. 2004; 56: 67-73
- Two-hour Algorithm for Triage Toward Rule-out and Rule-in of Acute Myocardial Infarction Using High-sensitivity Cardiac Troponin T.The American Journal of Medicine. 2015; 128: 369-379
- Demand at the emergency department front door: 10-year trends in presentations.The Medical Journal of Australia. 2012; 196: 128-132
- The angina management programme: a rehabilitation treatment.British Journal of Cardiology. 1995; : 221-226
- Sublingual nitroglycerin practices in patients with coronary artery disease in Australia.Journal of Cardiovascular Nursing. 2010; 25: 480-486
- High risk-factor level and low risk-factor knowledge in patients not accessing cardiac rehabilitation after acute coronary syndrome.Medical Journal of Australia. 2007; 186: 21
- Psychologic Morbidity and Health-Related Quality of Life of Patients Assessed in a Chest Pain Observation Unit.Ann Emerg Med. 2001; 38: 369-376
- Natural History and predictors of outcome for non cardaic chest pain: A prospective 4 year cohort study.Neurogastroenterology and Motility. 2008; 20: 989-997
- Determinants of Emergency Department Use: Are Race and Ethnicity important?.Ann Emerg Med. 1996; 28: 677-682
- Systematic review of trends in emergency department attendances: An Australian Perspective.Emerg Med J. 2010; 28: 373-377
National Heart Foundation of Australia. Will you recognise your heart attack. [cited 22.4.2016]. Available from: https://www.heartfoundation.org.au/images/uploads/publications/WS_Patient_Fact_Sheet_English.pdf.
- The heaviest repeat users of an inner city emergency department are not general practice patients.Emerg Med J. 2003; 15: 322-329
- Heavy users of an emergency department-Psycho-social and medical characteristics other health care contacts and the effect of a hospital social worker.Social Sciences Medicine. 1985; 21: 761-770
- Unit PHID Atlas of Avoidable Hospitalisations in Australia: ambulatory care-sensitive conditions. University of Adelaide, Adelaide2007
- Effectiveness of case management strategies in reducing emergency department visits in frequent user patient populations: A systematic review.The Journal of Emergency Medicine. 2013; 44: 717-729
- Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial.The American Journal of Emergency Medicine. 2008; 26: 155-164
- Coaching Patients of Achieving Cardiovascular Health (COACH).Archives of Internal Medicine. 2003; 163: 2775-2783
- Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home.Cochrane Database of Systematic Reviews. 2006;
- Health Independence Program Guidelines.2008 ([cited 13.01.2017]. Available from: http://www.health.vic.gov.au/subacute/hip-manual08.pdf)
- Reducing risk in heart disease: an expert guide to clinical practice for secondary prevention of coronary heart disease.National Heart Foundation of Australia, Melbourne2010 ([cited 19.01.2016]. Available from: http://heartfoundation.org.au/for-professionals/clinical-information/cardiac-rehabilitation-for-health-professionals)
- A randomized trial of a telephone care-management strategy.The New England Journal Of Medicine. 2010; 363: 1245-1255
Published online: April 19, 2017
Accepted: March 6, 2017
Received in revised form: March 1, 2017
Received: January 14, 2017
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.