Chest Pain

The importance of acute, subacute, or chronic recurring non-traumatic thoracic pain cannot be overestimated. In the U.S. it is the commonest presentation to the E.R. and among the most frequent medical reasons for hospitalization. Yet less than 10% of all patients presenting to physician's offices with chest pain have a significant medical condition.

Up to 80% of all stress tests with or without radionuclides are normal, and over half of all patients subjected to coronary arteriography have normal or non-critical narrowing of their coronary arteries. Of patients admitted yearly to coronary care units in the U.S., 500,000 or more do not have an acute MI. At an average hospital charge of $30,000 for 2-3 days in a CCU plus the estimated charges for unnecessary stress tests and arteriography, we estimate the total cost to the health care system for excessive investigation and overdiagnosis of chest pain is in the range of $35-$40 billion.

Yet while inappropriate hospitalizations drive up costs, undiagnosed MI's drive up malpractice claims. According to the Pennsylvania State Medical Society, failure to make an early diagnosis of an acute myocardial infarction (AMI) is the third most common cause of malpractice suits and paid claims against GP's and internists in the state. The average physician in Pennsylvania now pays about $25,000 a year in malpractice premiums, and the average claim for a missed AMI diagnosis or improper treatment is about $150,000. Nationally, the average claim for a missed heart attack is closer to $250,000.