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Revista Colombiana de Cardiología
Print version ISSN 0120-5633
Abstract
ALZATE-GUTIERREZ, Natalia; ROLDAN-TORO, Hernán; GALLO-VILLEGAS, Jaime and ARISTIZABAL-OCAMPO, Dagnovar. Effectiveness of the chest pain unit at primary level of health care with telecardiology: a quasi-experimental study of interrupted time series. Rev. Colomb. Cardiol. [online]. 2021, vol.28, n.4, pp.324-333. Epub Oct 18, 2021. ISSN 0120-5633. https://doi.org/10.24875/rccar.m21000062.
Introduction:
Chest pain units (CPU) decrease morbi-mortality in patients with acute coronary syndrome (ACS). Nevertheless, its effectiveness at primary level of health care with telecardiology support is unknown.
Objective:
To evaluate effectiveness of CPU on times of observation, diagnostic agreement and emergency department re-admission and hospitalizations.
Method:
Quasi-experimental study of robust interrupted time series, which included 20,412 patients admitted to the emergency department for chest pain, before and after the implementation of a CPU. Changes in slope, level, autocorrelation and, variance between both periods (before-CPU and after-CPU) in outcomes at 30 day follow-up were analyzed.
Results:
Subjects had a mean age of 44.9 ± 17.6 years-old and 45.8% were men. The overall rate of hospital admission was 9.0%. The slope of emergency re-consultation rates decreased (difference: −1.23; 95% CI: −2.46 to −0.01; p = 0.049), when comparing the two observation periods. Also, the level of proportion of patients admitted without ACS who finally had an inpatient diagnosis of ACS decreased after-CPU implementation (difference: −8.31; 95% CI: −15,52 to −1.11; p = 0.020).
Conclusions:
The CPU increased patient discharge safely with a reduction of 30-day re-admissions. In addition, an improvement in the ACS diagnostic agreement without affecting the time of observation or the frequency of re-hospitalization for cardiovascular disease was obtained during the follow-up.
Keywords : Chest pain; Acute coronary syndrome; Emergency medical services; Hospital admission; Time series studies.