Chest-pain follow-up linked to better survival, heart health

Chest-pain follow-up linked to better survival, heart health

NEW YORK - After an emergency-room visit for chest pain, people who follow-up with a doctor are less likely than those who don't do so to have a heart attack or die in the next year, Canadian researchers say.

Based on more than 200,000 patients at low risk for heart attack who were seen in an Ontario ER for chest pain, the study team found that almost 30 per cent never went for any kind of follow-up. But those who did tended to fare better.

"Patients often mistake being discharged from the emergency department for having a clean bill of health, but this is not necessarily true" said the study's senior author, Dr. Dennis Ko, a cardiologist at the University of Toronto's Sunnybrook Health Sciences Centre.

Doctors use follow-up appointments as an opportunity to pin down the cause of an individual's chest pain, which can be hard to do, Ko said, especially for patients without heart attack risk factors like diabetes or high blood pressure or pre-existing cardiac conditions.

After running more tests, the primary care doctor can refer the patient to a cardiologist or another specialist. Indeed, patients in the study who saw their primary care doctor and a cardiologist, or just a cardiologist, were the least likely to die or have a heart attack within a year of their ER visit.

"We were surprised that there really was a benefit to getting follow-up in this group because these patients did not have a lot of risk factors for heart disease," Ko told Reuters Health.

Chest Pain is one of the main symptoms of a heart attack, and according to the US Centers for Disease Control and Prevention, more than 5 million Americans visit an emergency room complaining of chest pain each year.

Medical guidelines state that after discharge, even patients with no apparent heart attack should be sent for a follow-up exam to investigate the chest pain.

In a past study, Ko's team had shown that people at high risk for heart disease did better if they followed-up an ER visit, although many of those patients didn't seek further treatment either.

To see whether follow-ups make a difference for low-risk patients, Ko and his colleagues analysed medical records for 216,527 patients who were discharged after having their chest pains assessed at an Ontario emergency department between April 2004 and March 2010.

The patients were all over age 50 and considered at low risk for heart disease because they did not have diabetes or any known heart risk factors. People with other serious illnesses, such as cancer, were excluded from the analysis.

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