CMAJ • November 23, 2004; 171 (11). doi:10.1503/cmaj.1041202.
© 2004 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters
Correspondance

Acute coronary syndromes

Steve Goodacre

Medical Care Research Unit, University of Sheffield, Sheffield, UK

Jim Christenson and colleagues,1 in their article about emergency department assessment of chest discomfort, state that chest pain evaluation units "are cost-effective relative to admitting all low-risk patients to coronary care units but have never been compared with the unstructured diagnostic approach used in most Canadian hospitals." However, more evidence for chest pain units has recently become available.

In a randomized controlled trial and economic evaluation, my colleagues and I compared a chest pain unit with routine care in the United Kingdom.2 Routine care consisted of an unstructured diagnostic approach, with hospital admission or discharge at the discretion of the physician. The chest pain unit was associated with fewer hospital admissions (37% v. 54%, p < 0.001), improved quality of life, and trends toward a lower proportion of those with acute coronary syndromes being discharged (6% v. 14%, p = 0.26) and lower health service costs (£478 v. £556, p = 0.25). Overall, the chest pain unit appeared more effective and more cost-effective than routine care.

Steve Goodacre Medical Care Research Unit University of Sheffield Sheffield, UK

Footnotes

Competing interests: None declared.


References

  1. Christenson J, Innes G, McKnight D, Boychuk B, Grafstein E, Thompson CR, et al. Safety and efficiency of emergency department assessment of chest discomfort. CMAJ 2004;170(12):1803-7. [Abstract/Free Full Text]
  2. Goodacre S, Nicholl J, Dixon S, Cross E, Angelini K, Arnold J, et al. Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ 2004; 328:254-7.[Abstract/Free Full Text]




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