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Follow-up after ED visit for chest pain less common in certain patients
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Nonclinical, system-based factors such as access to care and hospital volume were stronger predictors of physician follow-up after presentation to the ED with chest pain compared with patient factors.
Researchers evaluated 56,767 high-risk adult patients who presented with chest pain, were evaluated and discharged from an ED in Ontario, Canada, from April 2004 to March 2010. The primary outcome was physician follow-up within 30 days of discharge. The secondary outcome was cardiologist follow-up within 30 days of discharge.
Among the evaluated patients, 25.1% did not receive any physician follow-up, 69% were treated by a primary care physician and 17.3% were seen by a cardiologist within 30 days of discharge. Follow-up within the first week after discharge occurred in 46.1% of patients, including 37.3% with a PCP and 6.1% with a cardiologist.
Factors associated with reduced likelihood of receiving follow-up included the presence of medical comorbidities such as dementia (OR = 0.36; 95% CI, 0.32-0.41), hemiplegia or paraplegia (OR = 0.61; 95% CI, 0.52-0.71), and CV-related conditions, including MI (OR = 0.84; 95% CI, 0.8-0.88) and HF (OR = 0.89; 95% CI, 0.82-0.97).
The odds of physician follow-up were highest among patients who had visited a PCP (OR = 6.44; 95% CI, 5.91-7.01) or a cardiologist (OR = 1.36; 95% CI, 1.29-1.42) within the previous year. Patients who were evaluated in EDs with high annual chest pain volume were more likely to receive follow-up by any physician (OR = 1.52; 95% CI, 1.31-1.77) and a cardiologist specifically (OR = 2.04; 95% CI, 1.61-2.57).
Cardiologist follow-up also was more common if the patient had visited a cardiologist (OR = 3.01; 95% CI, 2.85-3.17) or was hospitalized (OR = 1.3; 95% CI, 1.23-1.36) within the previous year. Cardiologist follow-up was significantly less common among patients with medical comorbidities (P < .001).
“An improved strategy to ensure follow-up of patients, particularly for those who have not previously seen a physician, is needed to improve the transition of care,” the researchers concluded. – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.
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