Key result
Emergency department providers face an ethical dilemma balancing the risk of missing acute coronary syndrome against the potential harms of further cardiac workup in patients with low-risk chest pain.
Why the study?
Despite accelerated diagnostic protocols to risk-stratify potential ACS in EDs, fear of missing ACS motivates further testing, creating an ethical dilemma balancing ACS risk upon discharge against potential harms of a cardiac workup.
Providers must balance the risk of missing ACS with the potential harms of unnecessary cardiac workups using ethical principles.
Ethical tensions persist in low-risk chest pain evaluation despite validated ADPs; leaves open how best to integrate patient values into decisions.
Millions of patients present to US EDs each year with symptoms concerning for acute coronary syndrome (ACS), but fewer than 10% are ultimately diagnosed with ACS. Well-tested and externally validated accelerated diagnostic protocols were developed to aid providers in risk stratifying patients with possible ACS and have become central components of current ED practice guidelines. Nevertheless, the fear of missing ACS continues to be a strong motivator for ED providers to pursue further testing for their patients. An ethical dilemma arises when the provider must balance the risk of ACS if the patient is discharged compared with the potential harms caused by a cardiac workup. Providers should be familiar with the ethical principles relevant to this dilemma in order to determine what is in the best interests of the patient.
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Hendley et al. (2021) conducted an editorial in Low-risk chest pain concerning for acute coronary syndrome (ACS). Cardiac workup vs. Discharge without further testing was evaluated. Emergency department providers face an ethical dilemma balancing the risk of missing acute coronary syndrome against the potential harms of further cardiac workup in patients with low-risk chest pain.
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