BODY : NEW CRITERIA TO HELP DIAGNOSE CHEST PAIN.

Byline: Peter Modica Medical Tribune News Service

A team of doctors has developed criteria that can be used to determine whether a patient suffering from chest pain actually needs to be admitted to a coronary care unit (CCU).

Studies have shown that only about one-third of people referred to the CCU actually have had a heart attack. Sending them to an intermediate-care unit will save needed health-care dollars, the doctors said.

Patients should be referred to the CCU if they suffer from ischemia - a lack of oxygen to heart-muscle tissues caused by artery blockages, the new guidelines state.

But if a person does not have ischemia or does not exhibit other signs of a heart attack - severely irregular heartbeats, abnormally low blood pressure or heart failure - intensive care may not be necessary, said study head Dr. Anna N. A. Tosteson of Dartmouth Medical School in Hanover, N.H.

Instead, such patients should be sent to intermediate-care units, said Tosteson's colleague Dr. Thomas H. Lee of Brigham and Women's Hospital and Harvard Medical School in Boston. Intermediate-care units are less expensive, as there are fewer staff members per patient, he said.

``An intermediate care unit makes good, intuitive sense,'' said Dr. Andrew Buda, a staff cardiologist at Tulane University School of Medicine in New Orleans.

In many instances, doctors send patients with chest pain to the CCU even if they did not have a heart attack because there is nowhere else to monitor them carefully, Buda said.

``The study makes a lot of sense, particularly now when people are looking at ways of saving money, this certainly looks like a reasonable approach,'' he said.

The new study appears in the July 15 issue of the American Heart Association journal Circulation.

Tosteson and colleagues developed the new criteria after analyzing data on more than 12,000 emergency-room patients seen in hospitals in Connecticut, Massachusetts, Ohio and Michigan.

The patients were classified according to their findings on physical examination, lab tests and electrocardiogram (EKG), a machine that traces the rhythm of the heart beat.

Although nurses in an intermediate-care unit must look after more patients than in a CCU, patients are still monitored continually by nurses and technicians who can respond quickly to any problem that arises, including a heart attack, Tosteson said.

``This could potentially put a patient at risk depending on how low the level of care is,'' Buda said. ``But the whole idea is that these are low-risk patients who won't need intensive care.''

Intermediate-care units will be developed more and more as people begin recognizing their value and savings benefits, Buda said.