Not all patients can be evaluated this way. However, patients who met the physicians' criteria were able to be evaluated by the less costly method of exercise treadmill testing. Those who weren't candidates for this testing could be admitted to the hospital and didn't benefit very much from more costly stress imaging testing in the emergency department.

The evaluation of patients who come to the emergency department with chest pain is a major challenge. A system that evaluates symptoms and estimates the risk of each patient is useful in determining treatment protocols and the need for additional tests.

"Our strategy with exercise treadmill testing in selected patients helped us choose patients for hospital admission in a cost-effective and safe way," said Raymond Gibbons, M.D., Mayo Clinic cardiologist and one of the primary authors of the study.

The Mayo Clinic study looked at 212 intermediate-risk patients with unstable angina who were evaluated with chest pain units (CPU), a triage strategy to determine the severity of a patient's condition. Those patients were compared with 212 who were routinely admitted to Saint Marys Hospital in Rochester.

The researchers found that those who were eligible for the treadmill testing frequently had normal results and could be safely discharged from the emergency room without any significant events in the following six months. Those who were not eligible for the treadmill testing, such as those not capable of exercising, were frequently abnormal by stress imaging and usually admitted to the hospital.

"Referring this high-risk group for further stress imaging adds little benefit and is not cost-effective, primarily because of the high rate of
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1-Mar-2005