L Holsworth*¹,  L Dziukas¹, A Dart¹, G Jennings¹ M Hunter², L Grigg², P Cameron² P LeBrocq³, A Kambourakis³,  R Peveril³, S LeVasseur³

¹Dept of Cardiology and Emergency Medicine, The Alfred Hospital, Prahran, Vic. ²Dept of Cardiology and Emergency Medicine, Royal Melbourne Hospital, Parkville, Vic. ³Dept of Cardiology and Emergency Medicine, Monash Medical Center, Clayton, Vic.

Background American studies support the introduction of Chest Pain Evaluation Areas (CPEA) as an adjunct to emergency department (ED) management of chest pain.

Aim To assess the safety and effectiveness of an accelerated diagnostic protocol within a CPEA in the Australian setting.

Method CPEA's were established in three major Melbourne tertiary referral hospitals. All patients presenting to the ED with possible ischaemic chest pain and low to intermediate risk of adverse events were admitted to these areas.  Management protocols included continuous ECG and ST segment monitoring, serial cardiac enzyme measurements, cardiology review and investigations to exclude myocardial ischaemia.  All patients were followed up at 30 days to confirm final diagnosis and exclude post discharge acute coronary events.

Results During the initial six month period 656 patients were admitted to the CPEA's, representing 13% of total chest pain presentations to ED.  Of these, 78%(n=513) completed the protocol and were discharged to home. Subsequent investigations within this sub group diagnosed new onset acute coronary syndrome in 3%(n=18) patients at 30 days.  Post discharge events were identified in <0.6%(n=3) of these patients, these were AMI <0.4%(n=2) and death <0.2%(n=1).

The remaining 22%(n=143) of CPEA patients required in-patient admission and one non-cardiac death occurred whilst in CPEA.  Final discharge diagnosis confirmed 17%(n=25) AMI and 29%(n=41) Unstable Angina.

Conclusion Accelerated diagnostic protocols within a CPEA provide effective, safe management of chest pain within the ED.

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