Shared Decision Making Reduces Admissions in Low-Risk Chest Pain Patients

Summary and Comment |
December 5, 2016

Shared Decision Making Reduces Admissions in Low-Risk Chest Pain Patients

  1. Daniel M. Lindberg, MD

Use of a Web-based tool improved patient engagement and knowledge about risk and treatment options and decreased observation-unit admissions.

  1. Daniel M. Lindberg, MD

For chest pain patients with normal electrocardiogram and initial troponin results, adverse events are rare but serious. Some emergency physicians, guidelines, and clinical pathways recommend admission or observation for routine provocative testing in patients with low-risk chest pain, which can result in additional testing and significant cost.

Investigators studied 898 patients from six U.S. emergency departments who had low-risk chest pain and were being considered for admission for cardiac testing (stress test or coronary computed tomography). Patients were randomized to usual care or shared decision making facilitated by a decision aid. The Web-based decision aid took into account patients' personalized risk factors and reported their 45-day risk for major adverse cardiac events. Patients in both groups were surveyed immediately after the visit.

Patients randomized to the decision aid had increased knowledge of their risk and available options for their care and were more involved in decision making compared with those randomized to usual care. Conversations between the patient and physician took approximately 1 minute longer in the decision aid group. Significantly fewer patients in the decision aid group decided (with their clinician) to be admitted for further testing (37% vs. 52%). There were no major adverse events related to the intervention.

Comment

Beyond the concept of shared decision making, this study demonstrates the value of this particular publicly available tool. I plan to use the tool with all my low-risk chest pain patients, prior to observation-unit admission.

Editor Disclosures at Time of Publication

  • Disclosures for Daniel M. Lindberg, MD at time of publication Royalties UpToDate Grant / Research support Colorado Clinical and Translational Sciences Institute; Colorado Traumatic Brain Injury Trust Fund; Eunice Kennedy Shriver National Institute of Child Health and Human Development Editorial boards The Quarterly Update: Reviews of Current Child Abuse Medical Research; Child Abuse & Neglect: The International Journal Leadership positions in professional societies The Helfer Society (Executive Board Member at Large)

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Reader Comments (1)

BRAD SMITH

Confirms what was already suspected.

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