Erik P. Hess|Meghan Knoedler|Nilay D. Shah|Jeffrey A. Kline|Maggie Breslin|Megan E. Branda|Laurie Pencille|Brent R. Asplin|David M. Nestler|Annie T. Sadosty|Ian G. Stiell|Henry H. Ting|Víctor M. Montori
The Chest Pain Choice Decision Aid
background cardiac stress testing patients low risk acute coronary syndrome associated increased falsepositive test results unnecessary downstream procedures increased cost judged unlikely patient preferences driving decision obtain stress testing methods results chest pain choice trial prospective randomized evaluation involving 204 patients randomized decision aid usual care followed 30 days decision aid included 100person pictograph depicting pretest probability acute coronary syndrome available management options observation unit admission stress testing 2472 hours outpatient followup primary outcome patient knowledge measured immediate postvisit survey additional outcomes included patient engagement decision making proportion patients decided undergo observation unit admission cardiac stress testing compared usual care patients n103 decision aid patients n101 significantly greater knowledge 36 versus 30 questions correct mean difference 067 95 ci 03410 engaged decision making indicated higher option observing patient involvement scores 266 versus 70 mean difference 196 95 ci 16216 decided less frequently admitted observation unit stress testing 58 versus 77 absolute difference 19 95 ci 631 major adverse cardiac events discharge either group conclusions use decision aid patients chest pain increased knowledge engagement decision making decreased rate observation unit admission stress testing clinical trial registration url httpwwwclinicaltrialsgov unique identifier nct01077037