Effectiveness of the chest pain unit at primary level of health care with telecardiology: a quasi-experimental study of interrupted time series

Abstract

Introduction: Chest pain units (CPU) decrease morbi-mortality in patients with acute coronary syndrome (ACS). Nevertheless, its effectiveness at primary level of health care with telecardiology support is unknown. Objective: To evaluate effectiveness of CPU on times of observation, diagnostic agreement and emergency department re-admission and hospitalizations. Method: Quasi-experimental study of robust interrupted time series, which included 20,412 patients admitted to the emergency department for chest pain, before and after the implementation of a CPU. Changes in slope, level, autocorrelation and, variance between both periods (before-CPU and after-CPU) in outcomes at 30 day follow-up were analyzed. Results: Subjects had a mean age of 44.9 ± 17.6 years-old and 45.8% were men. The overall rate of hospital admission was 9.0%. The slope of emergency re-consultation rates decreased (difference: −1.23; 95% CI: −2.46 to −0.01; p = 0.049), when comparing the two observation periods. Also, the level of proportion of patients admitted without ACS who finally had an inpatient diagnosis of ACS decreased after-CPU implementation (difference: −8.31; 95% CI: −15,52 to −1.11; p = 0.020). Conclusions: The CPU increased patient discharge safely with a reduction of 30-day re-admissions. In addition, an improvement in the ACS diagnostic agreement without affecting the time of observation or the frequency of re-hospitalization for cardiovascular disease was obtained during the follow-up.