Acute chest pain is responsible for over half a million attendances per year at emergency departments in the UK.¹ Around 7% of such patients discharged home from emergency departments have prognostically significant myocardial damage.² Many others are discharged without a clear diagnosis. It, therefore, is clear that patients presenting to the emergency department with chest pain remain a management challenge.

The chest pain unit (CPU) uses early cardiac markers and exercise treadmill testing (ETT) to provide an effective and cost-effective way of managing these patients.³ Although many emergency departments use early cardiac markers to exclude a cardiac event, few hospitals use immediate ETT to risk …