Background: Chest pain is the second most common reason patients visit emergency departments (EDs) across the United States. To avoid missing a heart attack diagnosis, doctors frequently admit very low risk patients to the hospital when it is not necessary. This results in unnecessary patient worry and anxiety, untimely disruption in patients’ lives, unnecessary testing, and increased healthcare costs. We first developed a Web-based tool to reliably determine the future risk of a heart attack. Then, incorporating feedback from patients, doctors, and researchers, developed a patient education tool—Chest Pain Choice—to help patients better understand the tests that are being performed to determine the cause of their chest pain, what these tests might show, their individualized 45-day risk of a heart attack, and the available management options. In a study at the Mayo Clinic, researchers tested the impact of Chest Pain Choice by randomly selecting ED patients with chest pain to use the patient education tool with their clinician or to receive usual care. Compared to patients randomized to receive usual care, patients who used Chest Pain Choice were more knowledgeable about their care and their risk for a heart attack, were significantly more involved in the decision-making process, and chose to be admitted to the hospital less frequently without any adverse events.
Objectives: We want to improve care using the best science and taking into account patient values, preferences, and circumstances. In this study we plan to compare Chest Pain Choice to usual clinical care in four diverse hospitals. This will help patients and doctors know if Chest Pain Choice will work in their hospital.
Specific aim: We will test if Chest Pain Choice improves patient-centered outcomes and decreases health care utilization in four diverse hospital EDs.
Methods: Patients and other stakeholders have been and will continue to be involved throughout the research process. We will randomly select patients at low risk for a heart attack to receive Chest Pain Choice or usual care at four diverse hospitals. Expected impact: If the effectiveness of Chest Pain Choice is demonstrated in several diverse hospital emergency departments, it will improve patient-centered care for millions and safely decrease health care utilization.
Rising KL, Hollander JE, Schaffer JT, et al., Effectiveness of a Decision Aid in Potentially Vulnerable Patients: A Secondary Analysis of the Chest Pain Choice Multicenter Randomized Trial. Medical Decision Making (May 2017).
Hess EP, Hollander JE, Schaffer JT, et al., Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial, BMJ (December 2016).
Hess EP, Coylewright M, Frosch DL,et al., Implementation of shared decision making in cardiovascular care: past, present, and future, Circulation: Cardiovascular Quality & OutcomeI (September 2014).
Hess EP, Wyatt KD, Kharbanda AB, et al., Effectiveness of the head CT choice decision aid in parents of children with minor head trauma: study protocol for a multicenter randomized trial, Trials (June 2014).
Helping Patients with Chest Pain Make Decisions in the ER
A narrative explaining the monitoring and further testing emergency physicians often recommend—or urge—when they see patients with chest pain, even if they haven’t had a heart attack. A study shows benefits of patients’ and doctors’ using a decision aid to guide next steps.