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Chest Pain ED Movement since its inception has had as its goal to develop a partnership between emergency physicians and cardiologists in a continuous quality improvement process to enhance the delivery system of heart attack care through community penetration that links the user friendly approach (Chest Pain Center) with an early symptom heart attack community awareness program built on addressing reasons for delay when patients are having early symptoms. The perfection of the work up for patients with low probability of ischemic heart disease allows the hospital to reduce inappropriate admissions and missed MI’s from being sent home but most importantly opens the link to the community for additional patients encouraged by an early awareness program (infarctus interruptus).

Prodromal symptoms of an acute myocardial infarction have been known for over 75 years but have not been acted upon enough to improve heart attack care. Targeting patients with prodromal symptoms with a National Public Heatlth Program on the level of cholesterol reduction and hypertension control os now possible as these patients can be linked with chest pain centers who are prepared to deal with patients presenting with prodromal symptoms. The focus, thus will be on patients presenting with central chest discomfort, not perceived as chest pain, occurring intermittently and escaping detection by lack of recognition and reluctance to call 911 for fear of embarrassment when symptoms are mild. Making this message simple, widely desseminating it, and linking such patients with check out centers in hospital emergency departments is a strategy to bring about an effective penetration program at the local level. As hospitals continue to develop chest pain centers throughout the United States, the coalescence of these local community efforts will globally put us in the position to significantly reduce heart attack deaths.

Thus the chest pain center movement is a strategy that brings together cardiologists and emergency physicians in a CQI process with the goal to reduce time to treatment in patients with early evidence of early active ischemic heart disease. The new paradigm as seen in this light represents a shift in care to enhance present day management of patients with ischemic heart disease.