You’re not out of the woods if a doctor discharges you from the emergency room after you reported chest pain.
It may be a matter of life or death that you follow up within 30 days of your ER visit, even if all tests were normal.
“Many patients who present to the emergency department (ED) with chest pain have risk factors for heart disease,” says Geoffrey Barnes, MD, cardiologist and vascular medicine specialist at the University of Michigan Health System.
“So even if your tests in the emergency department are normal, it’s a good idea to check in with your primary care provider or a cardiologist shortly after your ED visit.
“This is a great time to discuss what may be causing your symptoms, identify risk factors for heart attack, and discuss ways to reduce your chance of a heart attack, stroke or other blood clot in the future.”
Seeing a cardiologist within 30 days of an ER visit for chest pain lowered the risk of a heart attack or mortality among high risk patients — according to a study report in the journal Circulation.
A high risk patient, as defined by this study, was one with previously diagnosed diabetes or heart disease.
A discharge from the ER doesn’t mean your heart is fine.
If a patient presents with symptoms that are classic for a heart problem (chest pain, shortness of breath), that patient will undergo tests that determine if they had a recent heart attack, and if they are currently having a heart attack.
They will not receive tests that determine their risk of a near-future heart attack.
How do I know this? I’ve taken my mother to the ER several times when she complained of suspicious symptoms including chest pain.
I know the routine: troponin test, chest X-ray, EKG, blood pressure monitoring, heart rate monitoring and stethoscope exam.
None of these tests can accurately indicate propensity for a near-future heart attack; my mother’s EKG was non-concerning, but she soon after needed a quintuple bypass.
This is why it’s so important for that within-30-day follow-up.
Though being discharged from the ER has a reassuring ring to it, it’s still crucial to follow up with your provider within 30 days to lower the risk of premature death.
Even if the emergency room physician doesn’t make a point of rearranging the follow-up care, this doesn’t mean the patient should be passive.
They need to be proactive and arrange that follow-up themselves.
Study Findings
Over 56,000 patients with chest pain were analyzed. Variables like gender, age and health status were accounted for.
– Seventeen percent of high risk chest pain patients were seen by a cardiologist within one month of their ER visit; and 58 percent saw a primary care doctor. One-quarter had no follow-up.
– Patients who saw a cardiologist were 21 percent less likely to suffer a heart attack or die within 12 months, and the figure for those who saw a primary care doctor was 7 percent, compared to those who had no follow-up.
– People who saw a cardiologist underwent more extensive exams within 100 days of their discharge from the ER and had the most favorable health outcomes.
– One year out: Patients who saw a cardiologist were 15 percent less likely to suffer a heart attack or die, compared to those who sought a follow-up with a primary care physician.
The study focused on only high risk patients and thus, the results may not be applicable to other demographics with chest pain. Further investigation is warranted.
Geoffrey Barnes, MD,
