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Possible Missed Acute Coronary Syndrome Rate in North Texas

Is There Room to Improve?

Chang, Mary P. MD, MPH*; Vigen, Rebecca MD, MSCS; Sharma, Sushma PhD; Diercks, Deborah B. MD, MSc§

doi: 10.1097/HPC.0000000000000188
Original Articles
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Background: Acute coronary syndrome (ACS) is a common diagnosis in the emergency department (ED). Missing this diagnosis may lead to increased morbidity or mortality. With improved cardiac biomarkers tests, it is unknown if that has decreased the prevalence of ACS diagnoses in ED patients who were recently evaluated in the ED.

Methods: This is a retrospective review of ED patients who were diagnosed with ACS and seen in the ED 7 and 30 days before that visit in North Texas between 2009 and 2015. The demographics and temporal trends of missed ACS rates are described. Logistic regression was used to evaluate if any factors (ie, age, ethnicity, sex, insurance status) were significant.

Results: Between December 26, 2008 and June 29, 2015, there were 24,914 diagnoses of ACS in the ED. The overall prevalence of patients diagnosed with ACS 7 days after their ED visit was 3.2% and 8.8% at 30 days. For patients diagnosed with ACS 7 days and 30 days after an ED visit, the most common initial ED diagnoses were nonspecific chest pain (57.7%), atherosclerotic disease (19.5%), and heart failure (12.8%). Between 2009 and 2015, there was no overall change in the rate of ACS diagnoses in patients seen 7 or 30 days before an ED visit.

Conclusions: The prevalence of missed ACS in the North Texas region at 7 and 30 days after the initial ED visit is low and has not changed over the past several years.

From the *Department of Emergency Medicine, University of Texas at Southwestern, Dallas, TX

Division of Cardiology, Department of Internal Medicine, University of Texas at Southwestern, Dallas, TX

Public and Population Health, The DFW Hospital Council Research and Education Foundation, Irving, TX

§Department of Emergency Medicine, University of Texas at Southwestern, Dallas, TX.

Received for publication November 29, 2018; accepted April 18, 2019.

No funding was received for this project.

Reprints: Mary P. Chang, MD, MPH, 5323 Harry Hines Blvd., Dallas, TX 75390–8579. E-mail: mary.chang@utsouthwestern.edu.

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