Don't Forget the Follow-Up After Chest Pain

Emergency room visits for chest pain often require follow-up care, but many patients were not getting it

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Chest pain bad enough to seek emergency care warrants follow-up, right? However, many patients may not get follow-up care after their ER visit.

A new study found that patients who already had a primary care doctor or cardiologist were more likely to have follow-up care than those who didn’t have a doctor. Patients seen in emergency rooms (ERs) with a high volume of chest pain patients were also more likely to have follow-up care.

"We initially thought that emergency department physicians would [prioritize] patients such that those with [more health problems that could affect the heart] would receive more physician follow-up care," the authors of this study wrote.

However, these researchers found that patients with more existing health problems were less likely to receive follow-up care after leaving the hospital. Sicker patients who probably should have had follow-up care were unlikely to get it unless they already had a doctor, these authors wrote.

Dennis T. Ko, MD, a cardiologist at the Schulich Heart Centre of the Sunnybrook Health Sciences Centre in Toronto, Canada, led a research group that studied records from nearly 57,000 patients treated between 2004 and 2010. All these patients were seen for chest pain in an ER.

Dr. Ko and team noted that chest pain is one of the most common reasons for an ER visit in Canadian adults. These researchers also noted that current clinical guidelines strongly recommend that patients with chest pain be seen again within 72 hours of an ER visit.

Dr. Ko and colleagues expected that sicker patients who had multiple health problems would be more likely to have follow-up care. What they found, however, was that having a family doctor or cardiologist was much more likely to result in follow-up care than the patient’s medical condition was.

These researchers found that 25.1 percent of the patients did not receive any follow-up care.

Patients who had a family doctor were six times more likely to receive follow-up care than those who didn’t have a doctor. Patients who had a cardiologist were three times more likely to receive follow-up care than those patients who had never seen a cardiologist.

In ERs with a high volume of chest pain patients, more patients were seen in follow-up. Dr. Ko’s team guessed that this might be because such hospitals may be more likely to have established relationships with primary care doctors and cardiologists who will accept referrals.

Dr. Ko and colleagues noted that their study was specific to the Canadian health system and might not apply to other countries. So what do these findings mean for the US?

Heart disease causes 1 of every 4 deaths in the US, according to the Centers for Disease Control and Prevention (CDC). Heart disease is the leading cause of death for both men and women. Almost 15 percent of Americans did not have a family doctor in 2013, according to the CDC.

Americans may lower their heart disease risk by eating a healthy diet, exercising regularly and not smoking. Having a regular doctor can also help patients maintain good health.

This study was published Feb. 23 in the Canadian Medical Association Journal.

The Sunnybrook Health Sciences Centre and the Sunnybrook Research Institute funded this research. Dr. Ko and team disclosed no conflicts of interest.

Review Date: 
February 22, 2015
Last Updated:
February 24, 2015