Chest pain units: A necessity or only a name to encourage patients

BACKGROUND: Acute chest pain is a common symptom among patients presenting to emergency wards. Identification and admission of patients with real acute coronary syndrome and preventing the hospitalization of people with false diagnosis of coronary syndrome are the most important tasks in emergency wards. The purpose of this study was to investigate the usefulness of designing a special chest pain unit in emergency department of Imam Khomeini Hospital (Ahvaz, Iran).    METHODS: The patients with markers of ongoing cardiac ischemia underwent selective coronary angiography. The chest pain unit protocol was applied to selected patients with no definite evidence of acute coronary syndrome or alternative pathology. The protocol consisted of twelve hours of observation and serial ۱۲-lead electrocardiography, transthoracic echocardiography, and biochemical testing followed by an exercise treadmill test. We compared the number of patients who were discharged after work up, discharged themselves against medical advice, admitted at coronary care unit (CCU), underwent invasive procedures or died between ۲۰۰۷ and ۲۰۱۰.    RESULTS: During ۲۰۱۰, ۴۳% of patients were discharged after evaluation in the chest pain unit. In ۲۰۰۷ however, ۲۶% were discharged following traditional assessments. The admission rate increased from ۲۳% in ۲۰۰۷ to ۳۶% in ۲۰۱۰. The percentage of patients who discharged themselves against medical advice decreased from ۳۷% in ۲۰۰۷ to ۱۴% in ۲۰۱۰. There was not a statistically significant difference between mortality rates in ۲۰۰۷ and ۲۰۱۰.    CONCLUSION: Providing a special chest pain unit in emergency ward in our condition is helpful. It reduces unnecessary admissions and improves patient satisfaction.       Keywords: Chest Pain Unit, Acute Coronary Syndrome, Myocardial Infarction