E-Journal of the Society of Chest Pain Centers

Spring 2003, Volume II, Number I

EDITORIAL

Ezra A. Amsterdam, MD, FACC
Member, Board of Trustees
Society of Chest Pain Centers
Professor of Medicine
Director of Coronary Care Unit
University of California Davis Health System
4860 Y Street, Suite 2820
Sacramento, CA 95817
eaamsterdam@ucdavis.edu
(916) 734-3764

Chest Pain Centers: Growth, Consensus, Evolving Issues

The Chest Pain Center concept has been increasingly adopted and the number of these units continues to grow in hospitals in the U.S. and abroad. The international aspect of this phenomenon is reflected by the participation of physicians from Europe, South America and Asia in our recent Congresses and continues in our forthcoming program in San Francisco. The growth of our Society and its broadening activities bear further witness to it leadership in the continuing development of the Chest Pain Center movement. The achievements of the past year by our Society are well described in President Joseph's commentary in his President's Message in this issue of the E-Journal of the Society of Chest Pain Centers and Providers.

The issues that have stimulated the growth of the Chest Pain Center movement are based on the common concerns of optimal patient care and cost-effective management of two divergent patient populations presenting with chest pain or its equivalent: those with high risk, in whom the primary goal is rapid identification and initiation of life-saving therapy, and those with low risk, in whom recognition allows an abbreviated hospital stay and safe discharge. Because of the success of accelerated diagnostic protocols, which have become standard for low risk patients presenting with chest pain, their length of stay is now measured in hours rather than days. This has been achieved while maintaining patient safety, reducing cost and conserving resources for high risk patients. The importance of these achievements is underlined by the fact that the low risk group of patients comprises a majority of those presenting to the emergency department with chest pain.

While most basic matters in the Chest Pain Center movement represent shared interests among clinicians around the globe, there are also unresolved areas that continue to evolve. These include concerns within countries and those that cross international boundaries. The articles by doctors Goodacare and McCord in this issue reflect several of these important areas. Dr. Goodacre reports on reasons why a cost-effectiveness model pertaining to Chest Pain Centers in this country does not apply to the United Kingdom in which the source of funding for health care derives from a central, government source. In that context, these units do not demonstrate the economic advantages parallel to this country's experience. However, Goodacre points out innovative approaches to evaluation of the benefits of Chest Pain Centers, cites the successes of certain centers in the U.K. and suggests a future course for further development. We look forward to hearing firsthand from Goodacre, a leader in his field in the U.K., at the Congress in May.

An area of concern to all clinicians working in Chest Pain Centers is improved speed and accuracy of patient evaluation. In search of this goal, electron beam computed tomography (EBCT) is undergoing evaluation in Chest Pain Centers, as it is in other clinical arenas. McCord presents the concepts underlying this technique and evaluates its potential role in risk stratifying patients in a Chest Pain Center. Based on his review of the initial studies of EBCT in this clinical context, he concludes that while there is potential for this method, there is currently insufficient data to support it as a replacement for stress testing of low risk patients in Chest Pain Centers. McCord is also actively involved in the Congress where, among his official roles, he chairs the Abstract Selection Committee.

As we move into the next year of the Society's growth, we look forward to participation by all our members in its activities, including submission of articles, reviews and letters to the E-Journal of the Society of Chest Pain Centers and Providers. We hope to meet you at the Congress in May.