Remote management of low to intermediate risk chest pain: A case series

Published:February 15, 2017DOI:


      We report a case series of three low to intermediate risk chest pain patients who presented to the emergency department and were managed as outpatients via the Cellular Outpatient Twelve-Lead Telemetry with Emergency Response (COTTER™). This technology allows for certain chest pain patients to be managed remotely via telemedicine while receiving care comparable to that which would be available in a hospital or chest pain observation unit.
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        • Bhuiya F.A.
        • Pitts S.R.
        • LF McCaig
        Emergency department visits for chest pain and abdominal pain: United States, 1999–2008.
        in: NCHS Data Brief, no 43. National Center for Health Statistics, Hyattsville, MD2010
        • Weinstock M.B.
        • Weingart S.
        • Orth F.
        • et al.
        Risk for clinically relevant adverse cardiac events in patients with chest pain at hospital admission.
        JAMA Intern. Med. 2015; 175: 1207-1212
        • Pope J.H.
        • Aufderheide T.P.
        • Ruthazer R.
        • Woolard R.H.
        • Feldman J.A.
        • Beshansky J.R.
        • et al.
        Missed diagnoses of acute cardiac ischemia in the emergency department.
        N. Engl. J. Med. 2010; 342: 1163-1170
        • Amsterdam E.A.
        • Wenger N.K.
        • Brindis R.G.
        • Casey Jr., D.E.
        • Ganiats T.G.
        • Holmes Jr., D.R.
        • et al.
        2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association task force on practice guidelines.
        J. Am. Coll. Cardiol. 2014; 64: e139-e228
        • Goodachre S.
        • Cross E.
        • Arnold J.
        • Angelini K.
        • Capewell S.
        • Nicholl J.
        The health care burden of acute chest pain.
        Heart. 2005; 91: 229-230
        • Leff B.
        • Burton L.
        • Mader S.L.
        • Naughton B.
        • Burl J.
        • Inouye S.K.
        • et al.
        Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients.
        Ann. Intern. Med. 2005; 143: 798-808
        • Wilson A.
        • Wynn A.
        • Parker H.
        Patient and carer satisfaction with ‘hospital at home’: quantitative and qualitative results from a randomised controlled trial.
        Br. J. Gen. Pract. 2002; 52: 9-13
        • Marsteller J.A.
        • Burton L.
        • Mader S.L.
        • Naughton B.
        • Burl J.
        • Guido S.
        • et al.
        Health care provider evaluation of a substitutive model of hospital at home.
        Med. Care. 2009; 47: 979-985
        • Mitchell A.E.
        • Garvey L.J.
        • Chandra A.
        • Diercks D.
        • Pollack C.V.
        • Kline J.A.
        Prospective multicenter study of quantitative pretest probability assessment to exclude acute coronary syndrome for patients evaluated in emergency department chest pain units.
        Ann. Emerg. Med. 2006; 47: 438-447
        • Crenshaw L.A.
        • Lindsell C.J.
        • Storrow A.B.
        • Lyons M.S.
        An evaluation of emergency physician selection of observation unit patients.
        Am. J. Emerg. Med. 2006; 24: 271-279
        • Weinstock M.
        • et al.
        Risk for clinically relevant cardiac events in patients with chest pain at hospital admission.
        AMA Intern Med. 2015; 175: 1207-1212
        • Katz D.A.
        • Williams G.C.
        • Brown R.L.
        • Aufderheide T.P.
        • Bogner M.
        • Rahko P.S.
        • et al.
        Emergency physicians' fear of malpractice in evaluating patients with possible acute cardiac ischemia.
        Ann. Emerg. Med. 2005; 46: 525-533
        • Milano P.
        • Carden D.L.
        • Jackman K.M.
        • Rongkavilit A.
        • Groves K.
        • Tyndall J.
        • et al.
        Compliance with outpatient stress testing in low-risk patients presenting to the emergency department with chest pain.
        Crit. Pathw. Cardiol. 2011; 10: 35-40

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