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In an interesting article, Cross et al1 showed that very few rapid diagnostic testing protocols and chest pain units (CPUs) have been developed to manage patients with acute undifferentiated chest pain in the UK over the last 5 years. Despite evidence to suggest that care in a CPU is more effective for such patients,2 the percentage of emergency departments (EDs) setting up these units has been as low as 13%, and mostly restricted to clinical trials.
In Spain, where EDs are chronically overcrowded,3 4 in 2002 the Spanish Society of Cardiology recommended that CPUs should be set up in all EDs to provide fast and efficient care for patients with chest pain.5 Since then, to our knowledge, only four centres have followed this advice. The cardiology service is running a CPU at one hospital6 while the ED is running it at others.7–9 The only structural CPU was launched in our ED in 2002 and, since then, it has clearly improved all quality markers defined for the care of chest pain.9 The poor development of CPUs in Europe greatly contrasts with their expansion in the USA where more than 1500 CPUs are currently available.10 The reasons for the lack of enthusiasm for CPUs in European countries should be urgently investigated.
Competing interests: None declared.
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