Baseline characteristics and factors associated with cardiology follow-up within 30 d of visiting an emergency department with chest pain
| Characteristic | No cardiology follow-up, no. (%)*n = 46 957 | Cardiology follow-up, no. (%)*n = 9 810 | Unadjusted OR (95% CI) | Adjusted OR (95% CI) |
|---|---|---|---|---|
| Age, yr, mean ± SD | 66.77 ± 14.95 | 65.11 ± 13.32 | ||
| < 50 (reference) | 6 508 (13.9) | 1 321 (13.5) | 1.00 | 1.00 |
| 50–69 | 18 034 (38.4) | 4 454 (45.4) | 1.22 (1.14–1.30) | 1.17 (1.08–1.26) |
| ≥70 | 22 415 (47.7) | 4 035 (41.1) | 0.89 (0.83–0.95) | 0.96 (0.89–1.04) |
| Male sex | 24 087 (51.3) | 5 809 (59.2) | 1.38 (1.32–1.44) | 1.14 (1.09–1.20) |
| Rural residency | 8 590 (18.3) | 1 018 (10.4) | 0.52 (0.48–0.55) | 0.98 (0.88–1.08) |
| Income quintile 1 (lowest) (reference) | 11784 (25.1) | 2 140 (21.8) | 1.00 | 1.00 |
| Income quintile 2 | 10 128 (21.6) | 2 090 (21.3) | 1.14 (1.06–1.21) | 1.07 (1.00–1.15) |
| Income quintile 3 | 9 214 (19.6) | 1 987 (20.3) | 1.19 (1.11–1.27) | 1.14 (1.06–1.22) |
| Income quintile 4 | 8 369 (17.8) | 1 818 (18.5) | 1.20 (1.12–1.28) | 1.10 (1.02–1.19) |
| Income quintile 5 (highest) | 7 462 (15.9) | 1 775 (18.1) | 1.31 (1.22–1.40) | 1.19 (1.10–1.28) |
| Cardiac risk factors or previous cardiovascular conditions | ||||
| Diabetes mellitus | 17 609 (37.5) | 2 954 (30.1) | 0.72 (0.69–0.75) | 0.93 (0.88–0.98) |
| Hypertension | 35 329 (75.2) | 7 293 (74.3) | 0.95 (0.91–1.00) | 0.99 (0.93–1.05) |
| Dyslipidemia | 18 581 (39.6) | 4 713 (48.0) | 1.41 (1.35–1.48) | 1.13 (1.08–1.19) |
| Chronic atherosclerosis | 21 700 (46.2) | 5 743 (58.5) | 1.64 (1.57–1.72) | 1.12 (1.06–1.18) |
| Unstable angina | 6 145 (13.1) | 1 438 (14.7) | 1.14 (1.07–1.21) | 0.92 (0.86–0.98) |
| Previous myocardial infarction | 12 001 (25.6) | 3 064 (31.2) | 1.32 (1.26–1.39) | 0.96 (0.91–1.02) |
| Previous admission for heart failure | 3 052 (6.5) | 714 (7.3) | 1.13 (1.04–1.23) | 1.11 (1.01–1.22) |
| Valvular heart disease | 2 293 (4.9) | 663 (6.8) | 1.41 (1.29–1.54) | 1.04 (0.94–1.14) |
| Arrhythmias | 11 787 (25.1) | 2 976 (30.3) | 1.30 (1.24–1.36) | 1.11 (1.02–1.22) |
| Atrial fibrillation | 7 980 (17.0) | 1 950 (19.9) | 1.21 (1.15–1.28) | 1.04 (0.95–1.15) |
| Ventricular arrhythmias | 804 (1.7) | 347 (3.5) | 2.11 (1.85–2.39) | 1.30 (1.11–1.51) |
| Shock | 1 096 (2.3) | 262 (2.7) | 1.15 (1.00–1.32) | 1.03 (0.88–1.19) |
| Peripheral vascular disease | 3 173 (6.8) | 574 (5.9) | 0.86 (0.78–0.94) | 0.87 (0.79–0.96) |
| Cerebrovascular disease | 5 576 (11.9) | 699 (7.1) | 0.57 (0.53–0.62) | 0.77 (0.70–0.84) |
| Previous medical conditions | ||||
| Respiratory disease | 6 039 (12.9) | 803 (8.2) | 0.60 (0.56–0.65) | 0.72 (0.66–0.78) |
| Peptic ulcer disease | 901 (1.9) | 158 (1.6) | 0.84 (0.71–0.99) | 0.91 (0.76–1.09) |
| Rheumatologic disease | 596 (1.3) | 94 (1.0) | 0.75 (0.61–0.94) | 0.90 (0.72–1.14) |
| Neurologic disease | 2 146 (4.6) | 166 (1.7) | ||
| Hemiplegia or paraplegia | 835 (1.8) | 79 (0.8) | 0.45 (0.36–0.57) | 0.71 (0.55–0.91) |
| Dementia | 1 363 (2.9) | 90 (0.9) | 0.31 (0.25–0.38) | 0.47 (0.38–0.59) |
| Renal disease | 2 842 (6.1) | 557 (5.7) | 0.93 (0.85–1.03) | 0.95 (0.86–1.06) |
| Cancer | 3 054 (6.5) | 520 (5.3) | 0.81 (0.73–0.89) | 0.89 (0.80–0.98) |
| Anemia or blood disease | 3 988 (8.5) | 656 (6.7) | 0.77 (0.71–0.84) | 0.92 (0.84–1.01) |
| Trauma | 3 751 (8.0) | 432 (4.4) | 0.53 (0.48–0.59) | 0.72 (0.65–0.81) |
| Depression | 2 491 (5.3) | 295 (3.0) | 0.55 (0.49–0.63) | 0.71 (0.62–0.80) |
| Charlson–Deyo comorbidity score‡ | 1.68 ± 1.64 | 1.47 ± 1.56 | ||
| Events in the emergency department | ||||
| Cardiologist consultation | 868 (1.8) | 559 (5.7) | 1.41 (1.29–1.54) | 2.03 (1.79–2.29) |
| Stress test | 203 (0.4) | 83 (0.8) | 0.84 (0.71–0.99) | 1.72 (1.29–2.29) |
| Discharged against medical advice | 716 (1.5) | 117 (1.2) | 1.41 (1.29–1.54) | 0.70 (0.57–0.87) |
| Use of health services in the previous year | ||||
| Primary care visit | 44 507 (94.8) | 9 354 (95.4) | 1.13 (1.02–1.25) | 0.88 (0.79–0.98) |
| Cardiologist visit | 17 285 (36.8) | 6 959 (70.9) | 4.19 (4.00–4.39) | 3.01 (2.85–3.17) |
| Admission to hospital | 23 263 (49.5) | 5 588 (57.0) | 1.35 (1.29–1.41) | 1.30 (1.23–1.36) |
| Hospital characteristics | ||||
| Teaching hospital | 7 750 (16.5) | 2 265 (23.1) | 0.84 (0.71–0.99) | 1.12 (0.88–1.44) |
| Cardiac catheterization laboratory | 13 083 (27.9) | 3 797 (38.7) | 1.41 (1.29–1.54) | 1.36 (1.09–1.70) |
| Annual chest pain volume, patients/yr | ||||
| Low (< 348) (reference) | 3 171 (6.8) | 260 (2.7) | 1.00 | 1.00 |
| Medium (348–1237) | 10 100 (21.5) | 1 258 (12.8) | 1.52 (1.32–1.75) | 1.46 (1.17–1.81) |
| High ( > 1237) | 33 686 (71.7) | 8 292 (84.5) | 3.00 (2.64–3.41) | 2.04 (1.61–2.57) |
Note: CI = confidence interval, ED = emergency department, OR = odds ratio, SD = standard deviation.
↵* Unless otherwise specified.
† Baseline demographics, cardiac risk factors and medical conditions, events in the emergency department, use of health services in the previous year and hospital characteristics were included in the model.
↵‡ Not included in the prediction model because each individual component was adjusted.