Key result
Direct discharge from the emergency department for chest pain resulted in a 28-day unexpected death rate from acute coronary syndrome or arrhythmia of 0.01% (95% CI 0-0.011%).
Why the study?
The rate of unexpected death from acute coronary syndrome or arrhythmia among chest pain patients directly discharged from the ED needed to be defined.
Observational (n=25,924)
No
Unexpected death from acute coronary syndrome or arrhythmia is extremely rare (0.01%) within 28 days of direct discharge from the emergency department for chest pain.
Very low unexpected mortality after ED discharge for chest pain does not support practice change; leaves open prospective validation of risk stratification.
OBJECTIVES: We sought to define the rate of unexpected death from acute coronary syndrome or arrhythmia in chest pain patients directly discharged from the ED. METHODS: Retrospective audit of all chest pain patients at a tertiary ED for 7 years. Medical and post-mortem records of the deceased were reviewed with independent cardiologist adjudication to determine outcomes. Primary outcome measure was 28-day unexpected death secondary to acute coronary syndrome or arrhythmia. RESULTS: During the study period, 25 924 patients presented with chest pain, 292 (1.1%, 95% confidence interval [CI] 0.99-1.01%) died within 28 days. Of these, 16 680(64%, 95% CI 63.88-64.12%) were discharged by ED, two (0.01%, 95% CI 0-0.011%) of this group died from the primary outcome. CONCLUSION: Unexpected death is very uncommon after ED discharge of chest pain patients.
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Loten et al. (2023) conducted an observational in Chest pain (n=25,924). Direct discharge from the emergency department was evaluated on 28-day unexpected death secondary to acute coronary syndrome or arrhythmia (95% CI 0-0.011). Direct discharge from the emergency department for chest pain resulted in a 28-day unexpected death rate from acute coronary syndrome or arrhythmia of 0.01% (95% CI 0-0.011%).
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