CARE-CP (Testing a Cardiovascular Ambulatory Rapid Evaluation for Patients With Chest Pain )
Wake Forest University Health Sciences
Summary
The goal of this study is to determine if rapid outpatient evaluation vs hospitalization management is the best strategy (based on patient-centered measures and safe, equitable, and efficient resource use) for evaluating patients with acute chest pain who are at moderate risk for acute coronary syndrome (ACS). Patients will be randomized in the Emergency Department to either an outpatient evaluation (CARE-CP) or hospitalization evaluation for their symptoms.
Description
Current care patterns for the 7 million patients visiting Emergency Departments (EDs) in the United States with chest pain are heterogeneous and not sustainable from a healthcare quality or economic perspective. Chest pain is the second most common cause of ED visits and the most common reason for short-stay hospitalizations. During these hospitalizations patients undergo in-depth evaluations (stress testing, computed tomography coronary angiography, or invasive angiography), but ultimately \<10% are diagnosed with acute coronary syndrome (ACS). These evaluations cost $3 billion annually and s…
Eligibility
- Age range
- 21+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Age ≥21 years old * Chest pain or Symptoms of acute coronary syndrome (ACS) * Moderate risk of ACS (all of the below) * Hear Score 4-6 * Non-Ischemic electrocardiogram (ECG) * Two Troponin measures \< Sex-Specific Upper Reference Limit * Women \<15 pg/ml * Men \<20 pg/ml * No prior coronary artery disease (CAD) * No Prior Myocardial Infarction (MI) * No Prior Coronary Revascularization Procedures * No Patients with ≥ 70% Obstructive Coronary Disease Exclusion Criteria: * ST Elevation Myocardial Infarction (STEMI) Activation * ST Changes or new T-wave invers…
Interventions
- BehavioralOutpatient Evaluation
Subjects will receive an outpatient evaluation within 72 of being discharged from the ED.
- BehavioralHospitalization Evaluation
Patients randomized to this arm receive evaluation for their symptoms in a hospital ward, observation unit, or emergency department boarding.
Locations (3)
- Henry Ford HospitalDetroit, Michigan
- Carolinas Medical CenterCharlotte, North Carolina
- Wake Forest University Health SciencesWinston-Salem, North Carolina