A cohort study of chest pain patients discharged from the emergency department for early outpatient treadmill exercise stress testing


  • Richard Paoloni, MBBS, FACEM, MMed (Clinical Epidemiology), Director of Emergency Medicine, Associate Professor; Razaq Ibuowo, MBBS, FRCS, Emergency Registrar.

Correspondence: Associate Professor Richard Paoloni, c/o Emergency Department, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia. Email: Richard.paoloni@sswahs.nsw.gov.au



Guidelines on intermediate-risk chest pain, based on consensus alone, recommend inpatient provocative testing after infarct exclusion. Inpatient testing exceeds capacity in many hospitals, so guidelines concede outpatient testing within 72 h is acceptable. We performed a cohort study of chest pain patients having early outpatient treadmill exercise stress testing (EST).


All chest pain patients discharged from our emergency with booked outpatient treadmill EST during the 2008 to 2010 calendar years were included. There were no exclusions. The primary outcome was diagnosis of major coronary artery disease among stress test attendees. Secondary outcomes were time to stress test booking, representations with chest pain or death within 30 days.


The cohort consisted of 657 patients: 59% men, mean age 53.2 years. Time from discharge to stress test averaged 10.6 days and 73% of patients attended. Of patients who attended, 14% had a positive test and 13% an inconclusive result. These patients were older than those with negative results (P < 0.001). Four patients (0.8% of attendees) were diagnosed with major coronary artery disease. There were no representations with acute myocardial infarction and no deaths identified.


Outpatient treadmill EST an average of 10 days post-discharge from emergency with chest pain did not result in adverse events despite reasonably high positive stress test rates. Consensus-based recommendations for inpatient testing or outpatient testing within 72 h of discharge should be reviewed in light of these data.