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Published in: Clinical Research in Cardiology 11/2015

Open Access 01-11-2015 | Review

Criteria of the German Society of Cardiology for the establishment of chest pain units: update 2014

Authors: Felix Post, Tommaso Gori, Evangelos Giannitsis, Harald Darius, Stephan Baldus, Christian Hamm, Rainer Hambrecht, Hans Martin Hofmeister, Hugo Katus, Stefan Perings, Jochen Senges, Thomas Münzel

Published in: Clinical Research in Cardiology | Issue 11/2015

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Abstract

Since 2008, the German Cardiac Society (DGK) has been establishing a network of certified chest pain units (CPUs). The goal of CPUs was and is to carry out differential diagnostics of acute or newly occurring chest pain of undetermined origin in a rapid and goal-oriented manner and to take immediate therapeutic measures. The basis for the previous certification process was criteria that have been established and published by the task force on CPUs. These criteria regulate the spatial and technical requirements and determine diagnostic and therapeutic strategies in patients with chest pain. Furthermore, the requirements for the organization of CPUs and the training requirements for the staff of a CPU are defined. The certification process is carried out by the DGK; currently, 225 CPUs are certified and 139 CPUs have been recertified after running for a period of 3 years. The certification criteria have now been revised and updated according to new guidelines.
Literature
1.
go back to reference Breuckmann F, Post F, Giannitsis E, Darius H, Erbel R, Görge G, Heusch G, Jung W, Katus H, Perings S, Senges J, Smetak N, Münzel T (2008) Kriterien der Deutschen Gesellschaft für Kardiologie–Herz- und Kreislaufforschung für “Chest-Pain-Units”. Kardiologe 2(5):389–394CrossRef Breuckmann F, Post F, Giannitsis E, Darius H, Erbel R, Görge G, Heusch G, Jung W, Katus H, Perings S, Senges J, Smetak N, Münzel T (2008) Kriterien der Deutschen Gesellschaft für Kardiologie–Herz- und Kreislaufforschung für “Chest-Pain-Units”. Kardiologe 2(5):389–394CrossRef
3.
go back to reference Perings S, Smetak M, Block M et al (2010) Konsensuspapier der Task Force “Brustschmerz. Ambulanz” der Deutschen Gesellschaft für Kardiologie–Herz- und Kreislaufforschung. Kardiologe 4(3):1–5CrossRef Perings S, Smetak M, Block M et al (2010) Konsensuspapier der Task Force “Brustschmerz. Ambulanz” der Deutschen Gesellschaft für Kardiologie–Herz- und Kreislaufforschung. Kardiologe 4(3):1–5CrossRef
4.
go back to reference Hamm CW, Bassand JP, Agewall S et al (2011) ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 32(23):2999–3054CrossRefPubMed Hamm CW, Bassand JP, Agewall S et al (2011) ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 32(23):2999–3054CrossRefPubMed
5.
go back to reference Arntz HR, Bossaert LL, Danchin N, Nikolaou NI (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 5. Initial management of acute coronary syndromes. Resuscitation 81(10):1353–1363CrossRefPubMed Arntz HR, Bossaert LL, Danchin N, Nikolaou NI (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 5. Initial management of acute coronary syndromes. Resuscitation 81(10):1353–1363CrossRefPubMed
6.
go back to reference Keller T, Post F, Tzikas S et al (2010) Improved outcome in acute coronary syndrome by establishing a chest pain unit. Clin Res Cardiol Offi J German Card Soc 99(3):149–155CrossRef Keller T, Post F, Tzikas S et al (2010) Improved outcome in acute coronary syndrome by establishing a chest pain unit. Clin Res Cardiol Offi J German Card Soc 99(3):149–155CrossRef
7.
go back to reference Kugelmass A, Anderson A, Brown P (2004) Does having a chest pain center impact the treatment and survival of acute myocardial infarction patients? Circulation 110:111 (abstract) Kugelmass A, Anderson A, Brown P (2004) Does having a chest pain center impact the treatment and survival of acute myocardial infarction patients? Circulation 110:111 (abstract)
8.
go back to reference Post F, Genth-Zotz S, Munzel T (2007) Aktueller Stellenwert einer Chest Pain Unit in Deutschland. Herz 32(5):435–437 Post F, Genth-Zotz S, Munzel T (2007) Aktueller Stellenwert einer Chest Pain Unit in Deutschland. Herz 32(5):435–437
9.
go back to reference Post F, Genth-Zotz S, Munzel T (2007) Versorgung des akuten Koronarsyndroms in einer Chest Pain Unit-Eine sinnvolle Neuerung in Deutschland. Klinikarzt 36:375–380CrossRef Post F, Genth-Zotz S, Munzel T (2007) Versorgung des akuten Koronarsyndroms in einer Chest Pain Unit-Eine sinnvolle Neuerung in Deutschland. Klinikarzt 36:375–380CrossRef
10.
go back to reference Dougan JP, Mathew TP, Riddell JW et al (2001) Suspected angina pectoris: a rapid-access chest pain clinic. QJM 94(12):679–686CrossRefPubMed Dougan JP, Mathew TP, Riddell JW et al (2001) Suspected angina pectoris: a rapid-access chest pain clinic. QJM 94(12):679–686CrossRefPubMed
11.
go back to reference Goodacre S, Dixon S (2005) Is a chest pain observation unit likely to be cost effective at my hospital? Extrapolation of data from a randomised controlled trial. Emerg Med J. 22(6):418–422PubMedCentralCrossRefPubMed Goodacre S, Dixon S (2005) Is a chest pain observation unit likely to be cost effective at my hospital? Extrapolation of data from a randomised controlled trial. Emerg Med J. 22(6):418–422PubMedCentralCrossRefPubMed
12.
go back to reference Goodacre S, Nicholl J, Dixon S et al (2004) Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ 328(7434):254PubMedCentralCrossRefPubMed Goodacre S, Nicholl J, Dixon S et al (2004) Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ 328(7434):254PubMedCentralCrossRefPubMed
13.
go back to reference Tzikas S, Keller T, Post F, Blankenberg S, Genth-Zotz S, Munzel T (2010) Patient satisfaction in acute coronary syndrome. Improvement through the establishment of a chest pain unit. Herz 35(6):403–409CrossRefPubMed Tzikas S, Keller T, Post F, Blankenberg S, Genth-Zotz S, Munzel T (2010) Patient satisfaction in acute coronary syndrome. Improvement through the establishment of a chest pain unit. Herz 35(6):403–409CrossRefPubMed
15.
go back to reference Post F, Giannitsis E, Riemer T et al (2012) Pre- and early in-hospital procedures in patients with acute coronary syndromes: first results of the “German chest pain unit registry”. Clin Res Cardiol Offi J German Card Soc 101(12):983–991CrossRef Post F, Giannitsis E, Riemer T et al (2012) Pre- and early in-hospital procedures in patients with acute coronary syndromes: first results of the “German chest pain unit registry”. Clin Res Cardiol Offi J German Card Soc 101(12):983–991CrossRef
16.
go back to reference Maier LS, Darius H, Giannitsis E et al (2013) The German CPU Registry: comparison of troponin positive to troponin negative patients. Int J Cardiol 168(2):1651–1653CrossRefPubMed Maier LS, Darius H, Giannitsis E et al (2013) The German CPU Registry: comparison of troponin positive to troponin negative patients. Int J Cardiol 168(2):1651–1653CrossRefPubMed
17.
go back to reference Akkerhuis KM, Klootwijk PA, Lindeboom W et al (2001) Recurrent ischaemia during continuous multilead ST-segment monitoring identifies patients with acute coronary syndromes at high risk of adverse cardiac events; meta-analysis of three studies involving 995 patients. Eur Heart J 22(21):1997–2006CrossRefPubMed Akkerhuis KM, Klootwijk PA, Lindeboom W et al (2001) Recurrent ischaemia during continuous multilead ST-segment monitoring identifies patients with acute coronary syndromes at high risk of adverse cardiac events; meta-analysis of three studies involving 995 patients. Eur Heart J 22(21):1997–2006CrossRefPubMed
18.
go back to reference Holmvang L, Andersen K, Dellborg M et al (1999) Relative contributions of a single-admission 12-lead electrocardiogram and early 24-hour continuous electrocardiographic monitoring for early risk stratification in patients with unstable coronary artery disease. Am J Cardiol 83(5):667–674CrossRefPubMed Holmvang L, Andersen K, Dellborg M et al (1999) Relative contributions of a single-admission 12-lead electrocardiogram and early 24-hour continuous electrocardiographic monitoring for early risk stratification in patients with unstable coronary artery disease. Am J Cardiol 83(5):667–674CrossRefPubMed
19.
go back to reference Hiratzka LF, Bakris GL, Beckman JA et al (2010) ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 121(13):e266–e369CrossRefPubMed Hiratzka LF, Bakris GL, Beckman JA et al (2010) ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 121(13):e266–e369CrossRefPubMed
20.
go back to reference Erbel R, Alfonso F, Boileau C et al (2001) Diagnosis and management of aortic dissection. Eur Heart J 22(18):1642–1681CrossRefPubMed Erbel R, Alfonso F, Boileau C et al (2001) Diagnosis and management of aortic dissection. Eur Heart J 22(18):1642–1681CrossRefPubMed
21.
go back to reference Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29(18):2276–2315CrossRefPubMed Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29(18):2276–2315CrossRefPubMed
22.
go back to reference Steg PG, James SK, Atar D et al (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33(20):2569–2619CrossRefPubMed Steg PG, James SK, Atar D et al (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33(20):2569–2619CrossRefPubMed
23.
go back to reference Keller T, Zeller T, Peetz D et al (2009) Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 361(9):868–877CrossRefPubMed Keller T, Zeller T, Peetz D et al (2009) Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 361(9):868–877CrossRefPubMed
24.
go back to reference Kurz K, Giannitsis E, Becker M, Hess G, Zdunek D, Katus HA (2011) Comparison of the new high sensitive cardiac troponin T with myoglobin, h-FABP and cTnT for early identification of myocardial necrosis in the acute coronary syndrome. Clin Res Cardiol Offi J German Card Soc 100(3):209–215CrossRef Kurz K, Giannitsis E, Becker M, Hess G, Zdunek D, Katus HA (2011) Comparison of the new high sensitive cardiac troponin T with myoglobin, h-FABP and cTnT for early identification of myocardial necrosis in the acute coronary syndrome. Clin Res Cardiol Offi J German Card Soc 100(3):209–215CrossRef
25.
go back to reference Bandstein N, Ljung R, Johansson M, Holzmann MJ (2014) Undetectable high sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. J Am Coll Cardiol 63(23):2569–2578CrossRefPubMed Bandstein N, Ljung R, Johansson M, Holzmann MJ (2014) Undetectable high sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. J Am Coll Cardiol 63(23):2569–2578CrossRefPubMed
26.
go back to reference Body R, Carley S, McDowell G et al (2011) Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay. J Am Coll Cardiol 58(13):1332–1339CrossRefPubMed Body R, Carley S, McDowell G et al (2011) Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay. J Am Coll Cardiol 58(13):1332–1339CrossRefPubMed
27.
go back to reference Reichlin T, Schindler C, Drexler B et al (2012) One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med 172(16):1211–1218CrossRefPubMed Reichlin T, Schindler C, Drexler B et al (2012) One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med 172(16):1211–1218CrossRefPubMed
28.
go back to reference Cullen L, Mueller C, Parsonage WA et al (2013) Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome. J Am Coll Cardiol 62(14):1242–1249CrossRefPubMed Cullen L, Mueller C, Parsonage WA et al (2013) Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome. J Am Coll Cardiol 62(14):1242–1249CrossRefPubMed
29.
go back to reference Maisel A, Mueller C, Neath SX et al (2013) Copeptin helps in the early detection of patients with acute myocardial infarction: primary results of the CHOPIN trial (Copeptin Helps in the early detection Of Patients with acute myocardial infarction). J Am Coll Cardiol 62(2):150–160CrossRefPubMed Maisel A, Mueller C, Neath SX et al (2013) Copeptin helps in the early detection of patients with acute myocardial infarction: primary results of the CHOPIN trial (Copeptin Helps in the early detection Of Patients with acute myocardial infarction). J Am Coll Cardiol 62(2):150–160CrossRefPubMed
30.
go back to reference Mockel M, Searle J, Hamm C, et al (2014) Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study. Eur Heart J Mockel M, Searle J, Hamm C, et al (2014) Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study. Eur Heart J
31.
go back to reference Blomkalns AL, Gibler WB (2005) Chest pain unit concept: rationale and diagnostic strategies. Cardiol Clin. 23(4):411–421CrossRefPubMed Blomkalns AL, Gibler WB (2005) Chest pain unit concept: rationale and diagnostic strategies. Cardiol Clin. 23(4):411–421CrossRefPubMed
33.
go back to reference Hamm CW (2009) Kommentar zu den Leitlinien der European Society of Cardiology (ESC) zur Diagnose und Therapie des akuten Koronarsyndroms ohne ST-Strecken-Hebung (NSTE-ACS). Der Kardiologe 3(2):81–100CrossRef Hamm CW (2009) Kommentar zu den Leitlinien der European Society of Cardiology (ESC) zur Diagnose und Therapie des akuten Koronarsyndroms ohne ST-Strecken-Hebung (NSTE-ACS). Der Kardiologe 3(2):81–100CrossRef
34.
go back to reference Mehta SR, Granger CB, Boden WE et al (2009) Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med 360(21):2165–2175CrossRefPubMed Mehta SR, Granger CB, Boden WE et al (2009) Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med 360(21):2165–2175CrossRefPubMed
35.
go back to reference Penaloza A, Melot C, Motte S (2011) Comparison of the Wells score with the simplified revised Geneva score for assessing pretest probability of pulmonary embolism. Thromb Res 127(2):81–84CrossRefPubMed Penaloza A, Melot C, Motte S (2011) Comparison of the Wells score with the simplified revised Geneva score for assessing pretest probability of pulmonary embolism. Thromb Res 127(2):81–84CrossRefPubMed
36.
go back to reference Shirakabe A, Hata N, Yokoyama S et al (2008) Diagnostic score to differentiate acute aortic dissection in the emergency room. Circ J 72(6):986–990CrossRefPubMed Shirakabe A, Hata N, Yokoyama S et al (2008) Diagnostic score to differentiate acute aortic dissection in the emergency room. Circ J 72(6):986–990CrossRefPubMed
37.
go back to reference Uthoff H, Staub D, Socrates T et al (2010) PROCAM-, FRAMINGHAM-, SCORE- and SMART-risk score for predicting cardiovascular morbidity and mortality in patients with overt atherosclerosis. Vasa 39(4):325–333CrossRefPubMed Uthoff H, Staub D, Socrates T et al (2010) PROCAM-, FRAMINGHAM-, SCORE- and SMART-risk score for predicting cardiovascular morbidity and mortality in patients with overt atherosclerosis. Vasa 39(4):325–333CrossRefPubMed
38.
go back to reference Bavry AA, Kumbhani DJ, Rassi AN, Bhatt DL, Askari AT (2006) Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol 48(7):1319–1325CrossRefPubMed Bavry AA, Kumbhani DJ, Rassi AN, Bhatt DL, Askari AT (2006) Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol 48(7):1319–1325CrossRefPubMed
39.
go back to reference O’Donoghue M, Boden WE, Braunwald E et al (2008) Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA 300(1):71–80CrossRefPubMed O’Donoghue M, Boden WE, Braunwald E et al (2008) Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA 300(1):71–80CrossRefPubMed
40.
go back to reference Dirschedl P, Lenz S, Lollgen H, Fahrenkrog U (1996) Validity of telephone ECG multichannel transmission. Z Kardiol 85(9):677–683PubMed Dirschedl P, Lenz S, Lollgen H, Fahrenkrog U (1996) Validity of telephone ECG multichannel transmission. Z Kardiol 85(9):677–683PubMed
41.
go back to reference Siebens K, Moons P, De Geest S, Miljoen H, Drew BJ, Vrints C (2007) The role of nurses in a chest pain unit. Eur J Cardiovasc Nurs 6(4):265–272CrossRefPubMed Siebens K, Moons P, De Geest S, Miljoen H, Drew BJ, Vrints C (2007) The role of nurses in a chest pain unit. Eur J Cardiovasc Nurs 6(4):265–272CrossRefPubMed
42.
go back to reference Breuckmann F, Post F, Erbel R, Munzel T (2009) Acute thoracic pain: Chest Pain Unit—the certification campaign of the German Society of Cardiology. Herz 34(3):218–223CrossRefPubMed Breuckmann F, Post F, Erbel R, Munzel T (2009) Acute thoracic pain: Chest Pain Unit—the certification campaign of the German Society of Cardiology. Herz 34(3):218–223CrossRefPubMed
43.
go back to reference Illmann A, Riemer T, Erbel R et al (2014) Disease distribution and outcome in troponin-positive patients with or without revascularization in a chest pain unit: results of the German CPU-Registry. Clin Res Cardiol Offi J German Card Soc 103(1):29–40CrossRef Illmann A, Riemer T, Erbel R et al (2014) Disease distribution and outcome in troponin-positive patients with or without revascularization in a chest pain unit: results of the German CPU-Registry. Clin Res Cardiol Offi J German Card Soc 103(1):29–40CrossRef
44.
go back to reference Nowak B, Giannitsis E, Riemer T et al (2012) Self-referral to chest pain units: results of the German CPU-registry. Eur Heart J Acute Cardiovasc Care 1(4):312–319PubMedCentralCrossRefPubMed Nowak B, Giannitsis E, Riemer T et al (2012) Self-referral to chest pain units: results of the German CPU-registry. Eur Heart J Acute Cardiovasc Care 1(4):312–319PubMedCentralCrossRefPubMed
45.
go back to reference Post F, Gori T, Senges J, Giannitsis E, Katus H, Munzel T (2012) Establishment and progress of the chest pain unit certification process in Germany and the local experiences of Mainz. Eur Heart J 33(6):682–686PubMed Post F, Gori T, Senges J, Giannitsis E, Katus H, Munzel T (2012) Establishment and progress of the chest pain unit certification process in Germany and the local experiences of Mainz. Eur Heart J 33(6):682–686PubMed
Metadata
Title
Criteria of the German Society of Cardiology for the establishment of chest pain units: update 2014
Authors
Felix Post
Tommaso Gori
Evangelos Giannitsis
Harald Darius
Stephan Baldus
Christian Hamm
Rainer Hambrecht
Hans Martin Hofmeister
Hugo Katus
Stefan Perings
Jochen Senges
Thomas Münzel
Publication date
01-11-2015
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 11/2015
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-015-0888-2

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