Shared Decision Making Reduces Admissions in Low-Risk Chest Pain Patients

For chest pain patients with normal electrocardiogram and initial troponin results, adverse events are rare but serious. Some emergency physicians, guidelines, and clinical pathways recommend admission or observation for routine provocative testing in patients with low-risk chest pain, which can result in additional testing and significant cost.

Investigators studied 898 patients from six U.S. emergency departments who had low-risk chest pain and were being considered for admission for cardiac testing (stress test or coronary computed tomography). Patients were randomized to usual care or shared decision making facilitated by a decision aid. The Web-based decision aid took into account patients' personalized risk factors and reported their 4…