The influence of referral source on characteristics of patients undergoing cardiac stress testing: emergency department versus outpatient office

Postgrad Med. 2011 Mar;123(2):36-41. doi: 10.3810/pgm.2011.03.2261.


Objectives: Chest pain is a common reason for accessing an emergency department (ED) and a frequent cause of outpatient physician visits. Whether patients referred for cardiac stress testing from these referral sources differ in clinically significant ways is unknown, and is thus the purpose of this investigation.

Methods: This study prospectively assessed 301 patients presenting to Virginia Commonwealth University Medical Center with symptoms suggestive of myocardial ischemia. All subjects underwent nuclear stress testing as a part of their assessment.

Results: Patients referred from the ED were more likely to be African American and outpatients were more likely to be Caucasian. Outpatients were older than those referred from the ED. Patients referred from the ED were less likely to have a diagnosis of hypertension, dyslipidemia, or diabetes, but were more likely to smoke. The exercise response was similar, with a few exceptions. There were no differences in the frequency of equivocal or positive nuclear stress test results based on referral source.

Conclusions: The results of the present study indicate that several characteristics of patients undergoing outpatient nuclear stress testing differ according to referral source. Future research should be directed toward developing effective strategies to reduce ED utilization and increasing outpatient management.

MeSH terms

  • Academic Medical Centers / statistics & numerical data
  • Chest Pain / diagnosis*
  • Chest Pain / epidemiology
  • Chest Pain / physiopathology
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / physiopathology
  • Emergency Service, Hospital / statistics & numerical data*
  • Exercise Test / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outpatients / statistics & numerical data
  • Prospective Studies
  • Referral and Consultation / statistics & numerical data*
  • Risk Factors
  • Tomography, Emission-Computed, Single-Photon