Chest Pain Unit: aktueller Stand und Entwicklungen

Zusammenfassung

Thorakale Schmerzen sind eine der häufigsten Ursachen für die Vorstellung von Patienten beim Notdienst und in der zentralen Notaufnahme. Bei kardialen Ursachen müssen die Patienten häufig stationär aufgenommen werden. In der kardiovaskulären Notfallmedizin ist es wichtig, dass der Notfallmediziner Patienten entsprechend einordnet und das Risikoprofil der Patienten erfasst, da ca. 10–30% der Fälle mit thorakalen Beschwerden ein akutes Koronarsyndrom (ACS) haben. Das Elektrokardiogramm und die Werte des hochsensitiven (hs) Troponins bei Aufnahme und im Verlauf nach 1 h und/oder 2 h sind für die Diagnose eines Myokardinfarkts zwingend erforderlich. Dies kann in Chest Pain Units (CPU), in der Notaufnahme oder separat standardisiert durchgeführt werden. Bei konventioneller Versorgung (ohne CPU-SOP) besteht ein nicht zu vernachlässigendes Risiko, dass 2–10% der Anginapatienten mit (sub-)akutem Myokardinfarkt fälschlicherweise nach Hause entlassen werden. Diese unzureichende Versorgung der ACS-Patienten geht mit langfristig erhöhten Kosten und dem Risiko einer Klage wegen fahrlässiger medizinischer Behandlung einher. Die Chest Pain Units (CPU) wurden vor ca. 2 Jahrzehnten in der Notfallversorgung in Deutschland eingeführt. Ziel war es, die Versorgung der Patienten zu verbessern, bei den Ärzten mehr Aufmerksamkeit zu erreichen, die Anzahl unnötiger Aufnahmen und Eingriffe zu reduzieren und dadurch die entstehenden Kosten zu senken. Dieses Ziel wird durch die Verwendung von Diagnoseprotokollen, Zeitvorgaben zur Versorgung, standardisierte Abläufe auch für Patienten mit thorakalen Beschwerden und anderen Diagnosen, vereinheitlichte Therapien und qualifizierte CPU-Mitarbeitern realisiert.

Abstract

Thoracic pain is one of the most common causes of patient presentation to emergency services and the central emergency department. When cardiac causes are present, patients often require hospitalization. In emergency cardiovascular medicine, it is important for the emergency physician to appropriately triage patients and assess the patient’s risk profile, as approximately 10–30% of cases with thoracic complaints have acute coronary syndrome. The electrocardiogram and high-sensitivity (hs) troponin values on admission and during the course after 1 h and/or 2 h are mandatory for the diagnosis of myocardial infarction. This can be performed in chest pain units, in the emergency department, or separately in a standardized manner. With conventional care (without CPU SOP), there is a non-negligible risk that 2–10% of angina patients with (sub-)acute myocardial infarction are wrongly discharged home. This inadequate care of ACS patients is associated with increased long-term costs and the risk of a lawsuit for negligent medical treatment. Chest pain units were introduced to emergency care in Germany approximately two decades ago. The goal was to improve patient care, increase physician awareness, reduce unnecessary admissions and interventions, and thereby reduce costs. This goal is realized through the use of diagnostic protocols, timelines for care, standardized procedures also for patients with thoracic complaints and other diagnoses and unified therapies and qualified CPU staff.

Schlüsselwörter

Troponin - Angina - Chest Pain Unit - akuter Myokardinfarkt - akutes Koronarsyndrom

Keywords

acute myocardial infarction - acute coronary syndrome - troponin - angina - chest pain unit

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