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  • What is an acceptable risk of major adverse cardiac event soon after discharge from emergency? The patient’s perspective

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Research letter
What is an acceptable risk of major adverse cardiac event soon after discharge from emergency? The patient’s perspective
  1. Jaimi H Greenslade1,2,
  2. Sarah Wilkinson1,
  3. William Parsonage2,3,
  4. Louise Cullen1,2,4
  1. 1 Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  2. 2 Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
  3. 3 Department of Cardiology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  4. 4 Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
  1. Correspondence to Dr Jaimi H Greenslade, Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; jaimi.greenslade{at}health.qld.gov.au

https://doi.org/10.1136/emermed-2021-212251

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    The assessment of patients with suspected acute coronary syndrome (ACS) incorporates ECGs and serial cardiac troponin values.1 Some patients then undergo further investigations (eg, exercise stress test or invasive coronary angiography) with risks of adverse events. For patients with a pretest probability of ACS less than 2%, the benefits of testing may not outweigh the risks.2 Engaging patients in discussions about their risks reduces the number admitted or undergoing stress testing.3 However, limited research has assessed patients’ tolerance for missed events while considering the risks of further testing. We investigated patients’ tolerance for risk of a missed diagnosis of ACS.

    This cross-sectional study used a convenience sample of adult patients (≥18) presenting with chest pain to an inner-city, publicly funded Emergency Department between December 2018 and July 2019. This study was approved by the institution’s ethics committee and patients provided written consent.

    A research assistant administered a questionnaire (online supplemental file 1) to the participants, recording baseline demographic information, self-assessment of previous heart trouble and self-assessment of health. Participants were asked whether they would like to have input or whether they would prefer the doctor to make decisions around their assessment. The participant was then asked to consider the scenario in box 1. Patients were asked whether …

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    Footnotes

    • Handling editor Edward Carlton

    • Twitter @louiseacullen

    • Contributors All authors met the requirement for authorship. JHG, SW, WP and LC conceived of and designed the study. JHG and SW were involved in acquisition of data. JG analysed the data, JHG, SW, WP and LC assisted with interpretation of the data. JHG and SW drafted the work, and all authors revised the manuscript critically for important intellectual content.

    • Funding JHG is funded by an Advance Queensland Fellowship.

    • Competing interests The authors declare no competing interests related to this work. Outside of the current work, William Parsonage, Louise Cullen and Jaimi Greenslade have had research grants paid to their institution from Siemens Healthcare, Abbott Point of Care, and Beckman Coulter. Jaimi Greenslade is funded by an Advance Queensland Fellowship.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.