Study suggests routine cardiac testing for ER patients with chest pain may be unnecessary

A new study suggests that routine cardiac testing of patients who come to the emergency department complaining of chest pain may not be warranted.

It’s common for emergency care clinicians to order more tests if they suspect the patient may have acute coronary syndrome (ACS). But researchers found that routine testing may increase the use of resources but not necessarily improve the outcomes of patients who come to the ER with chest pain but no other evidence or initial diagnosis of ischemia, according to a new study published in JAMA Internal Medicine.

The retrospective cohort analysis looked at national claims data of more than 925,000 privately insured patients between the ages 18 to 64 years old who came to the ER with chest pain. Weekday patients were more likely to receive testing compared to patients who came to the ER on the weekend. Researchers found that invasive and noninvasive cardiac testing of the relatively young patients didn’t lead to a reduction in subsequent hospital admissions for acute myocardial infarction.

“Our results show that cardiac testing is overused and reinforces the need to evaluate which, if any, patients with chest pain without evidence of ischemia benefit from noninvasive testing,” write lead author Alexander T. Sandhu, M.D., Stanford University Center for Primary Care and Outcomes Research, and the research team.

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The findings, according to an accompanying editorial in JAMA, are consistent with a rapidly “expanding evidence that challenges the current paradigm of early noninvasive testing after an ED evaluation for suspected ACS.”

In addition to the costs involved, the noninvasive testing may expose patients to injuries associated with radiation exposure, invasive angiography and cardiac revascularization procedures, Benjamin C. Sun, M.D., Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University and Rita F. Redberg, M.D., Division of Cardiology, University of California–San Francisco, wrote in the commentary.

They agree with researchers that further study is necessary to determine whether there is a benefit to the testing for patients who are at higher risk for ACS.