We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Low-Risk Chest Pain in the Emergency Department—Reply

Martin Than, MBBS1; Sally Aldous, MBBS1; Joanne Young, PhD1
[+] Author Affiliations
1Emergency Department, Christchurch Hospital, Christchurch, New Zealand
JAMA Intern Med. 2014;174(6):1010. doi:10.1001/jamainternmed.2014.914.
Text Size: A A A
Published online


In Reply We thank Drs Mark and Vinson for their sensible comments regarding our research1 and its implications. The experimental pathway incorporated a 2-hour accelerated diagnostic protocol, but some sort of secondary testing (usually exercise stress test) was also fundamental to the pathway unless clearly not indicated (eg, recent testing was already performed). The experimental pathway is now the standard of care in our hospital and still incorporates follow-up testing. There are no plans to remove this because after ruling out acute myocardial infarction there is still the possibility that a patient may have significant coronary artery disease and unstable angina. As demonstrated by the Global Registry of Acute Coronary Events study,2 unstable angina (even when treated) carries a significant onward mortality risk.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





June 1, 2014
Dustin G. Mark, MD; David R. Vinson, MD
1Department of Emergency Medicine, Kaiser Permanente, East Bay, Oakland, California
2Department of Emergency Medicine, Kaiser Permanente, Roseville, Roseville, California
JAMA Intern Med. 2014;174(6):1009-1010. doi:10.1001/jamainternmed.2014.924.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...