 |
|
|
  |
|
Clinical Overview
A Challenging Diagnosis
Chest pain suggestive of acute myocardial infarction (AMI), is the second most common emergency department (ED) presenting complaint, accounting for more than 5 million visits annually.1,2 Time is critical when evaluating patients who present with chest pain because of the threat of sudden death and the associated benefits of early treatment with thrombolytic or interventional therapies.3
Time is Critical!
A compelling relationship has been found between the elapsed time from onset of AMI symptoms to reperfusion therapy and patient outcome. The greatest reduction in mortality occurs among patients treated within 1-2 hours of onset of symptoms and is likely the result of early artery reopening and myocardial salvage.
 |
|
To view Myocardial Salvage Rates on a larger scale, click here. |
|
The Challenge of Chest Pain Diagnosis is Evident from the Facts:
| |
• |
Up to 30% of people who have MIs exhibit none of the traditional risk factors4 |
| |
• |
It is estimated that 50% of those who have MIs have normal lipids4 |
| |
• |
Only 50% of people experiencing an AMI have diagnostic ECG changes5 |
| |
• |
Of chest pain patients discharged, 2% - 5% will experience an MI within 48 hours1,2 |
| |
|
-
|
Inappropriate discharge from the ED is the highest risk of litigation for the emergency physician1 |
| |
• |
Less than 40% of AMI patients are actually diagnosed in time to receive thrombolytic therapy3 |
| |
• |
Less than 25% of chest pain patients admitted to the hospital for a definitive diagnosis suffer an MI5 |
| |
|
|
|
Saving Lives While Controlling Costs
Misdiagnosis of chest pain and AMI results in significant excess cost, including malpractice costs arising from failure to recognize AMI in the ED and hospitalization costs from erroneous assessment of chest pain as AMI. Each year, more than 25,000 AMI patients are estimated to be potentially misdiagnosed in the ED, mainly due to atypical symptom presentation. The total malpractice cost for missed AMIs each year is approximately $60 million or 20% to 39% of the ED medical malpractice costs.2,10
While the triage of patients with chest pain is a difficult challenge, admission of patients with a low probability of acute coronary disease can lead to excessive hospital costs. Costs associated with patients found to be free of acute disease have been estimated to be $6 billion in the United States each year.2
|
References |
|
|
|
 |
 |
 |
|
|
