Chest-pain follow-up linked to better survival, heart health

Jun 24 2014, 12:09 IST
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Chest Pain is one of the main symptoms of a heart attack. Chest Pain is one of the main symptoms of a heart attack.
SummaryMedical guidelines state that after discharge, even patients with no apparent heart attack should be sent for a follow-up exam to investigate the chest pain.

or any known heart risk factors. People with other serious illnesses, such as cancer, were excluded from the analysis.

The researchers looked at whether patients saw a primary care doctor or specialist within 30 days of their ER visit and tracked whether they died or had a heart attack in the 12 months after that.

During the first month, 29 percent of patients - almost 70,000 people - did not see any kind of doctor. Sixty percent saw at least their primary care doctor, 8 percent saw both a primary care doctor and a cardiologist and 4 percent of patients saw only a cardiologist.

Compared to patients who got no follow-up, those who saw both a primary care physician and a cardiologist had a 19 percent lower risk of heart attack or death in the next year. For those who saw just a cardiologist, the risk was 13 percent lower, the study team reports in the American Heart Journal.

Seeing just a primary care doctor was not linked to reduced risk compared to not seeing any doctor. Still, the authors emphasize that primary care typically plays an important “gatekeeper” role in referring patients to the right specialists.

Why so many patients never followed up their ER visit with any kind of doctor is unclear from the data the researchers had. But further studies should look at who would most benefit from follow-up attention and how to make sure they get it, the authors write.

“I think one of the most striking findings is that in a system where all medical costs are paid, 29 percent of patients did not follow up with any doctor after having chest pain,” Umesh Khot told Reuters Health.

Khot is a cardiologist at the Cleveland Clinic in Ohio and was not involved in the study. But he said it raises questions about how healthcare providers connect patients to outpatient care and highlights the fact that a lot of challenges remain.

“This tells me that even if you remove the issue of costs, a sizeable number of patients still do not follow-up. We tend to think that costs are the major barrier but this research indicates there are other barriers,” Khot said.

Among them, poverty or coping with other illnesses might make it too difficult to go for follow-up treatment, even if there is no charge, he speculated.

Khot said that patients not following-up on medical care is a problem throughout medicine. In the case of

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