Do you Know Your 45-day Heart Attack Risk?

Heart attack patients tend to skip stress test

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Patients educated about their potential risk of a heart attack tend to make different choices regarding emergency room testing when they suffer from chest pain.

Educated patients are more likely to skip a stress test, designed to determine the heart's function during physical stress, as compared to chest pain patients who are less aware of their heart attack risk.

"Discuss your heart attack risk with a cardiologist."

Dr. Erik P. Hess, lead author of the study and emergency room consultant at the Mayo Clinic in Minnesota, noted that emergency room doctors often opt for a stress test even for patients at very low risk of a heart attack to ensure they do not miss a diagnosis of a heart attack.

Dr. Hess said stress testing can result in false positive test results, unnecessary additional procedures, including tests that require radiation exposure, and increased medical costs.

As part of the study researchers designed a visual patient education tool to determine how care decisions could change if patients were educated about options for care and their 45-day heart attack risk.

Investigators then followed 204 emergency room patients who arrived suffering from chest pain and were being considered for stress testing. Half of the patients received the visual patient education aid, while the remainder did not.

The patients were surveyed immediately after their emergency room visit to analyze their knowledge and decision-making involvement. No major adverse heart problems were reported within 30 days of hospital discharge for patients in either group.

Patients in the group that received the decision assistance tool opted for stress testing 58 percent of the time as compared to 77 percent in the traditional care group. Patients that received the added assistance also were four times more involved in care decisions, and 75 percent said they would recommend the tool to others.

Patients in the decision aid group also were found much more knowledgeable about their heart attack risk and care options.

“This study suggests that low-risk patients don’t necessarily want extensive testing once a heart attack has been ruled out,” Dr. Hess said. “Informing patients of their risk and engaging them in the decision-making process may enable physicians and patients to work together to choose an approach to evaluation that is more in line with what patients want, without negatively affecting the results of their health care.”

The study findings were confirmed by utilizing the decision aid in a variety of other hospital emergency rooms. Dr. Hess noted that the decision aid requires follow up care 24 to 72 hours after patients leave the emergency room, and could be difficult to implement in medical centers with less access to outpatient follow up.

The study was recently published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

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Review Date: 
April 10, 2012
Last Updated:
April 11, 2012