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.
This information comes from a report in the March 2013 Circulation. 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.
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.
“Being discharged from the emergency department is reassuring for patients,” notes Dr. Dennis T. Ko, senior author, in the report, “but it is critical that they follow up with their doctor to reduce their risks of future heart attacks or premature death.”
Though Dr. Ko says that physicians need to be more aggressive about rearranging follow-up care, he also points out that patients need to be more proactive rather than play a passive role.
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.