Chest pain units

Evidence of their usefulness is limited but encouraging

Patients presenting to hospital with chest pain represent a substantial burden to the NHS. About 500 000 patients attend emergency departments in the United Kingdom each year with chest pain, 1 2 and 20–30% of all medical admissions are for acute chest pain.3 Currently most clinicians working in emergency departments rely on the history, clinical examination, and electrocardiogram (ECG) to decide which patients have acute coronary syndromes and need admission and which to send home. Given the unreliability of these tools alone to either rule in or rule out the diagnosis of acute myocardial infarction4 and unstable angina, it is not surprising that 2–4% of patients with acute myocardial infarction have been sent home from American emergency departments with a high case fatality rate and medicolegal costs. 5 6 The position in the United Kingdom is uncertain, but a recent study identified that 6% of patients who were discharged from …