The impact of follow-up care for patients presenting with non-typical chest pain at the emergency department

BACKGROUND: Failure to identify the underlying cause of chest pain in patients presenting to the cardiac emergency department (ED) poses a significant health and economic challenge. Non-typical chest pain in patients without a history of cardiovascular disease often leads to uncertainty regarding appropriate follow-up care. RESEARCH QUESTION: Does outpatient follow-up consultation with a cardiologist impact recurrent cardiac ED visits and major adverse cardiac and cerebrovascular events (MACCE) in patients with non-typical chest pain and no prior cardiovascular history? STUDY DESIGN AND METHODS: This retrospective cohort study included 429 patients presenting to the cardiac ED with non-typical chest pain and no history of cardiovascular disease. Of these, 213 patients (49.7%) received follow-up consultations with a cardiologist within three months of their index ED visit. We compared rates of recurrent (cardiac) ED visits, MACCE, and healthcare resource utilization during a one-year follow-up between patients who received follow-up consultations and those who did not. RESULTS: Patients with follow-up consultations had a significantly higher rate of revisits to the cardiac ED (13.6% vs. 5.1%) during the one-year follow-up period. There was no significant difference in MACCE between the two groups. Additionally, follow-up consultations were associated with an increase in healthcare resource utilization, including specialized cardiac tests. CONCLUSION: This study highlights the potential drawbacks of routine follow-up consultations in this patient population and calls for further prospective research to validate these findings.