Do emergency department patients with possible acute coronary syndrome have better outcomes when admitted to cardiology versus other services?

Abstract

Emergency physicians need to consider potential differences in quality of care across admitting services in their triage decisions. For emergency department (ED) patients with possible acute coronary syndrome who require hospitalization, there are relatively few data to guide emergency physicians in deciding whether admission to a cardiology service bed yields better outcomes than admission to a noncardiology service. We enrolled 544 ED patients who were admitted for symptoms of possible acute coronary syndrome after a nondiagnostic initial evaluation during a quality improvement trial at 2 university hospitals. Adverse events, inhospital treatment, and follow-up care were assessed by 30-day telephone interview and medical record review. We used a modified version of the Medical Outcomes Study Short Form 20 and the Duke Activity Status Index to assess functional status. To account for selection bias, we analyzed process and outcome variables after adjustment for the estimated propensity of being admitted to cardiology and predicted probability of acute cardiac ischemia. Overall, 34% of admitted patients had confirmed acute coronary syndrome. Patients admitted to a cardiology service were significantly more likely to undergo evaluation for ischemic heart disease than those admitted to a noncardiology service (adjusted odds ratio for noninvasive testing 2.7; 95% confidence interval 1.7 to 4.2) but were not more likely to receive recommended therapies. The incidence of ED revisits and rehospitalizations, functional status, and adverse cardiovascular events were similar in both groups. ED patients admitted for evaluation of possible acute coronary syndrome do not experience worsened short-term outcomes if admitted to a noncardiology service bed.