Please select the eligibility criteria that correspond to the clinical trial below.
Title: Acute Medical Admission of ELDERly Patients (≥75yrs) to Either Fast Track or Traditional Inward Hospitalisation. A Randomised Controlled Trial
Brief Summary: To evaluate differences in health outcomes among elderly patients (age ≥ 75 years) treated in a Quick Diagnostic Unit (QDU) compared to the Department of Internal Medicine (DIM). A QDU is a medical Short Stay Unit (SSU).


Options:
A: Inclusion Criteria:

* Age greater than or equal to 18 years of age at the time of enrollment
* Chest discomfort or other symptoms consistent with possible Acute Coronary Syndrome (ACS) as indicated by the treating physician after obtaining an Electrocardiogram (ECG) and cardiac biomarkers for the patient's evaluation
* Patient requires an inpatient evaluation for their chest pain
* The treating physician feels the patient could be discharged home if cardiac disease was excluded
* Thrombolysis in Myocardial Infarction (TIMI) risk score ≥ 2 OR physician clinical impression of intermediate or high likelihood that the symptoms represent ACS
* Negative pregnancy test (if sexually active, female, and of childbearing age)

Exclusion Criteria:

* Initial troponin I \> 1.0 ng/ml
* New ST-segment elevation on any electrocardiogram (≥ 1 mV)
* New ST-segment depression on any electrocardiogram (≥ 2 mV)
* Unable to lie flat
* Hypotension (systolic \< 90 mm Hg)
* Contra-indications to MRI(Pacemaker, defibrillator, cerebral aneurysm clips, metallic ocular foreign body, implanted devices, claustrophobia)
* Patient refusal of medical record review and telephone follow-up at 30 days
* Terminal diagnosis with life expectancy less than 3 months
* Pregnancy per patient report or positive pregnancy test (Center for Medicare \& Medicaid Services (CMS) exclusion criteria)
* Renal insufficiency(done prior to enrollment)or end stage renal disease
* Chronic liver disease (ex. hepatitis, cirrhosis)
* History of liver, heart, or kidney transplant
B: Inclusion Criteria:

1. Age ≥ 75 years
2. Admitted for in-hospital treatment for an internal medicine disease
3. Green tag triaged upon arrival in the ED

Exclusion Criteria:

1. Previous participation in this trial
2. Participation in other clinical trials
3. No QDU beds available
4. Subject does not have a Danish Civil Registration Number (CPR).
5. Subject resides abroad
6. Requires help using the toilet in daily life
7. Patients not aware of date, time and location, or their own data (name, birth date)
8. Informed consent cannot be obtained
C: Inclusion Criteria:

* Age greater than or equal to 21 years of age at the time of enrollment
* Chest discomfort or other symptoms consistent with possible ACS as indicated by the treating physician after obtaining an ECG and cardiac biomarkers for the patient's evaluation
* Thrombolysis in myocardial infarction (TIMI) risk score \>/= 2 or physician impression of intermediate or high likelihood symptoms represent ACS
* Patient requires an inpatient or CDU evaluation for their chest pain
* The treating physician feels the patient could be discharged home if cardiac disease was excluded
* The treating physician feels the patient is safe for CDU care

Pretest probability assessment The assessment of intermediate risk for developing ACS will be based on a TIMI risk score \>/= 2 and / or a board certified / board eligible emergency physician clinical impression of intermediate or high likelihood that the symptoms represent ACS. Physicians are encouraged to use the 2007 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines as a framework for this assessment.

Exclusion Criteria:

* Elevated cardiac biomarkers
* New ST-segment elevation on any electrocardiogram (\>/= 1 mV)
* New ST-segment depression on any electrocardiogram (\>/= 2 mV)
* Known inducible cardiac ischemia without subsequent revascularization
* Unable to lie flat
* Symptomatic hypotension at the time of enrollment (systolic \< 90 mm Hg)
* Contra-indications to MRI (examples: Pacemaker, defibrillator, cerebral aneurysm clips, metallic ocular foreign body, implanted devices, severe claustrophobia)
* Patient refusal or inability to comply with medical record review and follow up
* Terminal diagnosis with life expectancy less than 3 months
* Currently Pregnant
* Creatinine clearance \< 45 ml/min at the time of enrollment or clinical concern for acute kidney injury
* Chronic liver disease with a creatinine clearance of \<60 ml/min at the time of enrollment
* Hepato-renal syndrome
* History of liver, heart, or kidney transplant
* Confirmed angioplasty, stent placement, or coronary artery bypass grafting (CABG) within the last 6 months
D: Inclusion Criteria:

* Age greater than or equal to 18 years
* Chest discomfort or other symptoms consistent with possible ACS
* TIMI risk score ≥ 1 or physician impression\* of intermediate or high likelihood symptoms represent ACS
* Patient requires an inpatient or observation unit evaluation for their chest pain
* The treating physician feels the patient could be discharged home if cardiac disease was excluded
* ED attending feels patient is safe for observation unit care\*\*

Exclusion Criteria:

* Initial troponin I \> 1.0 ng/ml
* New ST-segment elevation (≥1mV) or depression (≥2 mV)
* Contra-indications to MRI (listed below)
* Unable to lie flat
* Hypotension (systolic \< 90 mm Hg)
* Renal insufficiency (estimated GFR \< 45 cc/min) or end stage renal disease
* Life expectancy less than 3 months
* Patient refusal of medical record review and follow-up at 30 days
* Pregnancy
* Liver, heart, or kidney transplant
* Chronic liver disease
* Unable to speak English or Spanish
* The ED attending feels that cardiac catheterization is indicated
* The ED care provider intends to order a CT coronary angiogram

(\*)Physicians are encouraged to use the 2007 ACC/AHA guidelines for the management of patients with NSTE ACS as a framework for this assessment.(1)

(\*\*)These patients should generally not be considered for observation unit care: PCI / CAGB in past 6 months, multiple stents, multiple prior MIs

Contraindications to MRI: (Pacemaker, defibrillator, cerebral aneurysm clips, metallic ocular foreign body, implanted devices, claustrophobia)

Answer: B