The chest pain choice decision aid: A randomized trial

Erik P. Hess, Meghan A. Knoedler, Nilay D. Shah, Jeffrey A. Kline, Maggie Breslin, Megan E. Branda, Laurie J. Pencille, Brent R. Asplin, David M. Nestler, Annie T. Sadosty, Ian G. Stiell, Henry H. Ting, Victor M. Montori

Research output: Contribution to journalArticle

165 Scopus citations

Abstract

Background-Cardiac stress testing in patients at low risk for acute coronary syndrome is associated with increased false-positive test results, unnecessary downstream procedures, and increased cost. We judged it unlikely that patient preferences were driving the decision to obtain stress testing. Methods and Results-The Chest Pain Choice trial was a prospective randomized evaluation involving 204 patients who were randomized to a decision aid or usual care and were followed for 30 days. The decision aid included a 100-person pictograph depicting the pretest probability of acute coronary syndrome and available management options (observation unit admission and stress testing or 24-72 hours outpatient follow-up). The primary outcome was patient knowledge measured by an immediate postvisit survey. Additional outcomes included patient engagement in decision making and the proportion of patients who decided to undergo observation unit admission and cardiac stress testing. Compared with usual care patients (n=103), decision aid patients (n=101) had significantly greater knowledge (3.6 versus 3.0 questions correct; mean difference, 0.67; 95% CI, 0.34-1.0), were more engaged in decision making as indicated by higher OPTION (observing patient involvement) scores (26.6 versus 7.0; mean difference, 19.6; 95% CI, 1.6-21.6), and decided less frequently to be admitted to the observation unit for stress testing (58% versus 77%; absolute difference, 19%; 95% CI, 6%-31%). There were no major adverse cardiac events after discharge in either group. Conclusions-Use of a decision aid in patients with chest pain increased knowledge and engagement in decision making and decreased the rate of observation unit admission for stress testing.

Original languageEnglish (US)
Pages (from-to)251-259
Number of pages9
JournalCirculation: Cardiovascular Quality and Outcomes
Volume5
Issue number3
DOIs
StatePublished - May 1 2012
Externally publishedYes

Keywords

  • Acute coronary syndrome
  • Diagnosis
  • Emergencies
  • Myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Hess, E. P., Knoedler, M. A., Shah, N. D., Kline, J. A., Breslin, M., Branda, M. E., Pencille, L. J., Asplin, B. R., Nestler, D. M., Sadosty, A. T., Stiell, I. G., Ting, H. H., & Montori, V. M. (2012). The chest pain choice decision aid: A randomized trial. Circulation: Cardiovascular Quality and Outcomes, 5(3), 251-259. https://doi.org/10.1161/CIRCOUTCOMES.111.964791