Decision aid Guides Chest Pain Emergency Patients

A one-page color printed handout facilitates emergency department (ED) doctor/patient discussion and assists doctors to safely eliminate unnecessary testing and procedures.

Developed by researchers at the Mayo Clinic (Rochester, MN, USA), the Chest Pain Choice (CPC) four-part decision chart is designed to guide emergency patients presenting with chest pain in treatment decisions. The graphic chart, developed with input from a patient advisory group and critique from clinicians, with friendly language and graphics used to educate when heart attack can be ruled out, explain stress testing and coronary CT angiography, provide a personal risk evaluation, and detail options for follow-up testing. On average, it takes a doctor just 80 seconds to go through the chart with a patient.


A study of the CPC was conducted at six EDs in five U.S. states, during which 898 adults with chest pain considered for ED observation admission for stress testing or coronary CT angiography were randomized to treatment using the CPC (447 participants) or standard care (451 participants). The results showed that the rate of patients choosing to have a stress test in the ED declined by 19%, and there was a 15% drop in the number of patients admitted to the hospital for stress tests. CPC patients said the chart was extremely clear, and that they would recommend a similar approach to others.

The patients treated with the CPC were also more knowledgeable than those given standard care about what their risks were for acute coronary syndrome (ACS) and available management options. Overall, 53% of those who got the CPC chart and discussed it with a physician later answered questions about chest pain correctly on a questionnaire, compared with 44.6% in the control arm. They were also twice as engaged in the decision-making process, as evaluated by an objective analysis of videotaped patient-physician interactions.

Likewise, physicians in the CPC intervention arm viewed the information as extremely clear, 66% said they would recommend using CPC to other clinicians, and a similar percentage said they would want to use the aid for other clinical decisions. The researchers noted that it is important to mention that the effect on mortality and adverse cardiac events of using the CPC chart was neutral. The study was presented at the American College of Cardiology (ACC) 65th annual scientific session, held during April 2016 in Chicago (IL, USA).

“The tool itself doesn’t recommend a specific management decision, it just makes transparent what the options are,” said lead author and study presenter Erik Hess, MD. “By setting out all the options, Chest Pain Choice enables patients to participate in their care decisions to the degree that they wish. Some patients, a small percentage, will simply ask the physician to decide for them.”

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Mayo Clinic