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Cost and outcomes of assessing patients with chest pain in an Australian emergency department

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Patients presenting with chest pain represent a large group of adult emergency department (ED) presentations.1 The most common serious underlying causes for this symptom are acute coronary syndromes (ACS), incorporating acute myocardial infarction and unstable angina pectoris. Over 5.5 million people presented to EDs in the United States in 2007–2008 with a primary complaint of chest pain, yet only 13% of those were diagnosed with an ACS.1 The number of patients presenting to EDs in Australia with a possible ACS is unknown.

Many conditions cause chest pain, yet discriminating between an ACS and alternative and generally less serious aetiologies, such as gastro-oesophageal reflux, is difficult. The 2006 National Heart Foundation and Cardiac Society of Australia and New Zealand (NHF/CSANZ) guidelines on the management of ACS recommended stratifying patients into low-, intermediate- and high-risk categories,2 a strategy that remained unchanged in more recent updates.3 The guidelines recommended that low-risk patients be assessed using serial cardiac biomarkers and electrocardiography. High-risk patients require admission to hospital and intensive management, often including early invasive strategies. The largest group is the intermediate-risk cohort, who require serial testing of biomarkers and electrocardiography.…