With the endorsement of multiple medical societies, the American College of Cardiology (ACC) and the American Heart Association (AHA) recently published the first clinical guideline devoted to the evaluation and management of adult patients presenting with a complaint of chest pain.
Editor's Note: This article originally appeared on ECG's website.
The guideline provides contemporary, much-needed clarity for standardizing linical evaluation, risk stratification, and diagnostic testing to manage the 95% of patients who ultimately do not require an emergent trip to the cardiac cath lab.
The First of Its Kind
With an estimated 6.5 million emergency department (ED) visits attributed to chest pain each year—visits that contribute significantly to the burden on US hospital EDs—it may seem surprising that this is the first clinical guideline aimed at the evaluation and management of chest pain in adult patients. However, it’s important to understand the context of our historical approach.
How Did We Get Here
Driven by a mission to reduce death and disability related to acute cardiac events, EDs in the US have employed “rapid rule out” strategies aimed at identifying and mitigating evolving or imminent myocardial injury events due to acute coronary syndrome (ACS). This mission has been very successful, producing highly effective, integrated STEMI systems of care that have reduced mortality and morbidity related to acute myocardial infarction. However, with tens of millions of ED visits in the rearview mirror, we now know that ACS is not the source of the complaint in the vast majority of the 6.5 million annual ED visits related to chest pain. In fact, more than half of these visits have a noncardiac source.
Toward a New Approach
Advances in cardiac imaging and pharmacology are fueling a contemporary approach to screening, prevention, early identification, and management of coronary artery disease (CAD). Clinical cardiologists armed with tools to evaluate both the anatomic and functional implications of CAD are able to provide patients with a highly individualized plan of care aimed at preventing disease progression and acute cardiac events. Click here to continue>>
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