REBEL EM - July 19, 2021 - By Marco Propersi
Paper: Musey PI Jr, Bellolio F, Upadhye S, et al. Guidelines for reasonable and appropriate care in the emergency department (GRACE): Recurrent, low-risk chest pain in the emergency department [published online ahead of print, 2021 Jul 6]. Acad Emerg Med. 2021. [PMID: DISCUSSION
These guidelines are comprehensive and pragmatic. However, they highlight how little evidence exists on recurrent low-risk chest pain and patient values and preferences for low-risk recurrent chest pain treatment. This lack of data represents an opportunity for future research to illuminate some gaps in knowledge. Also, of worthy discussion, some hospitals do not have high-sensitivity troponins. Therefore, some guidelines may not be applicable in all clinical settings. Likewise, expedited outpatient follow-up may also be difficult for some. Underinsured and uninsured patients are particularly vulnerable to follow-up loss. Accordingly, we often practice more cautiously with patients with limited resources. Moreover, the recommendations are based on derivative, indirect evidence stressing the importance of shared-decision making with our patients.
Clinical Bottom Line:
GRACE guidelines offer a pragmatic, evidence-based framework for shared-decision making in patients with recurrent low-risk chest pain.
