Key result
The overall prevalence of missed acute coronary syndrome in patients returning to the ED within 7 and 30 days was 3.2% and 8.8%, respectively, with no change between 2009 and 2015.
Why the study?
It is unknown whether improved cardiac biomarker tests have decreased the prevalence of ACS diagnoses in ED patients who were recently evaluated in the ED.
What is the prevalence and temporal trend of missed acute coronary syndrome diagnoses in the emergency department at 7 and 30 days?
Observational (n=24,914)
What is the prevalence and temporal trend of missed acute coronary syndrome diagnoses in the emergency department at 7 and 30 days?
The rate of missed acute coronary syndrome in the emergency department remains low at 3.2% at 7 days and 8.8% at 30 days, with no significant change over a 6-year period despite improved biomarker testing.
Stable missed ACS rates in ED returns should not change practice; leaves open whether targeted diagnostics reduce misses.
BACKGROUND: Acute coronary syndrome (ACS) is a common diagnosis in the emergency department (ED). Missing this diagnosis may lead to increased morbidity or mortality. With improved cardiac biomarkers tests, it is unknown if that has decreased the prevalence of ACS diagnoses in ED patients who were recently evaluated in the ED. METHODS: This is a retrospective review of ED patients who were diagnosed with ACS and seen in the ED 7 and 30 days before that visit in North Texas between 2009 and 2015. The demographics and temporal trends of missed ACS rates are described. Logistic regression was used to evaluate if any factors (ie, age, ethnicity, sex, insurance status) were significant. RESULTS: Between December 26, 2008 and June 29, 2015, there were 24,914 diagnoses of ACS in the ED. The overall prevalence of patients diagnosed with ACS 7 days after their ED visit was 3.2% and 8.8% at 30 days. For patients diagnosed with ACS 7 days and 30 days after an ED visit, the most common initial ED diagnoses were nonspecific chest pain (57.7%), atherosclerotic disease (19.5%), and heart failure (12.8%). Between 2009 and 2015, there was no overall change in the rate of ACS diagnoses in patients seen 7 or 30 days before an ED visit. CONCLUSIONS: The prevalence of missed ACS in the North Texas region at 7 and 30 days after the initial ED visit is low and has not changed over the past several years.
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Chang et al. (2019) conducted an observational in Acute coronary syndrome (n=24,914). Prior emergency department evaluation was evaluated on Prevalence of patients diagnosed with ACS 7 days and 30 days after an ED visit. The overall prevalence of missed acute coronary syndrome in patients returning to the ED within 7 and 30 days was 3.2% and 8.8%, respectively, with no change between 2009 and 2015.
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