1
|
Piccioni A, Baroni S, Manca F, Sarlo F, Savioli G, Candelli M, Bronzino A, Covino M, Gasbarrini A, Franceschi F. Multi-Marker Approach in Patients with Acute Chest Pain in the Emergency Department. J Pers Med 2024; 14:564. [PMID: 38929785 PMCID: PMC11204991 DOI: 10.3390/jpm14060564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Chest pain is a prevalent reason for emergency room referrals and presents diagnostic challenges. The physician must carefully differentiate between cardiac and noncardiac causes, including various vascular and extracardiovascular conditions. However, it is crucial not to overlook serious conditions such as acute coronary syndrome (ACS). Diagnosis of acute myocardial infarction (AMI) and early discharge management become difficult when traditional clinical criteria, ECG, and troponin values are insufficient. Recently, the focus has shifted to a "multi-marker" approach to improve diagnostic accuracy and prognosis in patients with chest pain. METHODS This observational, prospective, single-center study involved, with informed consent, 360 patients presenting to the emergency department with typical chest pain and included a control group of 120 healthy subjects. In addition to routine examinations, including tests for hsTnI (Siemens TNIH kit), according to the 0-1 h algorithm, biochemical markers sST2 (tumorigenicity suppression-2) and suPAR (soluble urokinase plasminogen activator receptor) were also evaluated for each patient. A 12-month follow-up was conducted to monitor outcomes and adverse events. RESULTS We identified two groups of patients: a positive one (112 patients) with high levels of hsTnI, sST2 > 24.19 ng/mL, and suPAR > 2.9 ng/mL, diagnosed with ACS; and a negative one (136 patients) with low levels of hsTnI, suPAR < 2.9 ng/mL, and sST2 < 24.19 ng/mL. During the 12-month follow-up, no adverse events were observed in the negative group. In the intermediate group, patients with hsTnI between 6 ng/L and the ischemic limit, sST2 > 29.1 ng/mL and suPAR > 2.9 ng/mL, showed the highest probability of adverse events during follow-up, while those with sST2 < 24.19 ng/mL and suPAR < 2.9 ng/mL had a better outcome with no adverse events at 12 months. CONCLUSION Our data suggest that sST2 and suPAR, together with hsTnI, may be useful in the prognosis of cardiovascular patients with ACS, providing additional information on endothelial damage. These biomarkers could guide the clinical decision on further diagnostic investigations. In addition, suPAR and sST2 emerge as promising for event prediction in patients with chest pain. Their integration into the standard approach in PS could facilitate more efficient patient management, allowing safe release or timely admission based on individual risk.
Collapse
Affiliation(s)
- Andrea Piccioni
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168 Roma, Italy; (F.M.); (M.C.); (A.B.); (M.C.); (F.F.)
| | - Silvia Baroni
- Unit of Chemistry, Biochemistry and Clinical Molecular Biology, Department of Laboratory and Hematological Sciences, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (S.B.); (F.S.)
| | - Federica Manca
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168 Roma, Italy; (F.M.); (M.C.); (A.B.); (M.C.); (F.F.)
| | - Francesca Sarlo
- Unit of Chemistry, Biochemistry and Clinical Molecular Biology, Department of Laboratory and Hematological Sciences, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (S.B.); (F.S.)
| | - Gabriele Savioli
- Departement of Emergency, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Marcello Candelli
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168 Roma, Italy; (F.M.); (M.C.); (A.B.); (M.C.); (F.F.)
| | - Alessandra Bronzino
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168 Roma, Italy; (F.M.); (M.C.); (A.B.); (M.C.); (F.F.)
| | - Marcello Covino
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168 Roma, Italy; (F.M.); (M.C.); (A.B.); (M.C.); (F.F.)
| | - Antonio Gasbarrini
- Medical and Surgical Science Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Francesco Franceschi
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168 Roma, Italy; (F.M.); (M.C.); (A.B.); (M.C.); (F.F.)
| |
Collapse
|
2
|
Mumtaz ZUA, Desai SR, Padley SPG. Frequency of extracardiac findings on "negative" CT coronary angiography studies. Clin Radiol 2024; 79:e334-e343. [PMID: 38092649 DOI: 10.1016/j.crad.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 01/02/2024]
Abstract
AIM To evaluate the prevalence and nature of extracardiac findings identified on computed tomography (CT) coronary angiography (CTCA) in patients with chest pain but without evidence of coronary artery disease (CAD). MATERIALS AND METHODS CTCA studies in patients referred to the hospital between January 2017 to February 2021 with chest pain and a suspected diagnosis of CAD were reviewed retrospectively for the presence of extracardiac findings. Consensus review of CTCA studies was performed by two experienced thoracic radiologists. The presence and severity of extracardiac findings, together with the likelihood that chest pain might be attributed to these, was recorded. Patient records were reviewed to ascertain the recording of extracardiac findings on initial CTCA reports and, where applicable, the nature of the follow-up. RESULTS Extracardiac findings (n=210) were present in 110/180 patients (61%) with a mean of 1.9 findings per patient. Extracardiac findings were more prevalent in patients aged ≥65 years compared to those <65 years (p<0.001). At least one extracardiac finding with the potential to cause chest pain was present in 40 patients (22%): degenerative disc disease (n=23 [13%]) and hiatus hernia (n=6 [3.3%]) were the most common extracardiac findings. Only 37.6% (79) of all retrospectively identified findings had been initially reported and, of these, 12.7% (10) required further follow-up. CONCLUSION Extracardiac findings are common in patients with no evidence of CAD on CTCA. The entire dataset should be evaluated for the presence of extracardiac findings that could explain chest pain symptoms on wide field of view reconstructions.
Collapse
Affiliation(s)
- Z-U-A Mumtaz
- Faculty of Medicine, Imperial College School of Medicine, London, UK.
| | - S R Desai
- Department of Radiology, Royal Brompton and Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK; Margaret Turner-Warwick Centre for Fibrosing Lung Diseases, Imperial College London, UK
| | - S P G Padley
- Department of Radiology, Royal Brompton and Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| |
Collapse
|
3
|
Bahall M, Kissoon S, Islam S, Panchoo S, Bhola-Singh N, Maharaj M, Khan F, Marajh S, Maharaj A, Legall G. Patients With Atypical Chest Pain: Epidemiology and Reported Consequences. Cureus 2024; 16:e53076. [PMID: 38414689 PMCID: PMC10896710 DOI: 10.7759/cureus.53076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Approximately a quarter of the global population experiences chest pain during their lifetime worldwide. Although largely non-life-threatening, many patients experience mental, physical, social, and financial consequences. AIM This study aimed to describe and determine the epidemiology and consequences of patients presenting with atypical chest pain (ACP). Method: Data were obtained from 102 participants, from a desired sample size of 166. The target population was patients who presented with ACP at the Accident and Emergency Department of a Teaching Hospital in Trinidad during a two-year period, from January 2021 to December 2022. The data collection instrument used was a 34-item online questionnaire. Data were analyzed using both descriptive and inferential statistical methods. RESULTS Participants were predominantly women (63.7%; n = 65), between 31 and 50 years of age (74.5%; n = 76), in full-time employment (n = 58; 56.9%), who lived with at least one person (90.2%; n = 92) at the time of the episode. Overall, 61.8% (n = 63) reported having a stressful life. Hypertension (30.4%; n = 31) and diabetes (18.6%; n = 19) were the leading comorbidities. Participants experienced mild to severe anxiety (53.9%; n = 55), moderate to severe depression (25.5%; n = 26), moderate stress (65.7%; n = 67), and loneliness (25.5%; n = 26). A stressful life was associated with, and was a predictor of, both anxiety and loneliness. No sociodemographic variables were associated with depression or stress. The most common self-reported consequences were "fear as a result of the pain" (68.6%; n = 69), "interruptions to daily life" (60.8%; n = 61), "reduction in time spent on hobbies" (62.7%; n = 63), and costly diagnostic/investigative tests (62.7%; n = 64). The majority of patients (52.9%; n = 53) reported reduced quality of life. The most common treatment prescribed was paracetamol (53.9%; n = 55) and exercise (23.5%; n = 24). CONCLUSION The study participants were mainly women, 31-50 years old, who had experienced anxiety, stress, or depression. They mainly experienced fear and self-reported a reduced quality of life.
Collapse
Affiliation(s)
- Mandreker Bahall
- Caribbean Center for Health Systems Research and Development, University of the West Indies, St. Augustine Campus, Marabella, TTO
| | - Sherece Kissoon
- Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, San Juan, TTO
| | - Samiha Islam
- Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, San Juan, TTO
| | - Sarah Panchoo
- Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, San Juan, TTO
| | - Naomi Bhola-Singh
- Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, San Juan, TTO
| | - Mitra Maharaj
- Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, San Juan, TTO
| | - Fiyad Khan
- Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, San Juan, TTO
| | - Sathyadeep Marajh
- Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, San Juan, TTO
| | - Aishwarya Maharaj
- Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, San Juan, TTO
| | - George Legall
- Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, San Juan, TTO
| |
Collapse
|
4
|
Lindskou TA, Andersen PJ, Christensen EF, Søvsø MB. More emergency patients presenting with chest pain. PLoS One 2023; 18:e0283454. [PMID: 36952460 PMCID: PMC10035919 DOI: 10.1371/journal.pone.0283454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Throughout recent years the demand for prehospital emergency care has increased significantly. Non-traumatic chest pain is one of the most frequent complaints. Our aim was to investigate the trend in frequency of the most urgent ambulance patients with chest pain, subsequent acute myocardial infarction (AMI) diagnoses, and 48-hour and 30-day mortality of both groups. METHODS Population-based historic cohort study in the North Denmark Region during 2012-2018 including chest pain patients transported to hospital by highest urgency level ambulance following a 1-1-2 emergency call. Primary diagnoses (ICD-10) were retrieved from the regional Patient Administrative System, and descriptive statistics (distribution, frequency) performed. We evaluated time trends using linear regression, and mortality (48 hours and 30 days) was assessed by the Kaplan Meier estimator. RESULTS We included 18,971 chest pain patients, 33.9% (n = 6,430) were diagnosed with"Diseases of the circulatory system" followed by the non-specific R- (n = 5,288, 27.8%) and Z-diagnoses (n = 3,634; 19.2%). AMI was diagnosed in 1,967 patients (10.4%), most were non-ST-elevation AMI (39.7%). Frequency of chest pain patients and AMI increased 255 and 22 patients per year respectively, whereas the AMI proportion remained statistically stable, with a tendency towards a decrease in the last years. Mortality at 48 hours and day 30 in chest pain patients was 0.7% (95% CI 0.5% to 0.8%) and 2.4% (95% CI 2.1% to 2.6%). CONCLUSIONS The frequency of chest pain patients brought to hospital during 2012-2018 increased. One-tenth were diagnosed with AMI, and the proportion of AMI patients was stable. Almost 1 in of 4 high urgency level ambulances was sent to chest pain patients. Only 1 of 10 patients with chest pain had AMI, and overall mortality was low. Thus, monitoring the number of chest pain patients and AMI diagnoses should be considered to evaluate ambulance utilisation and triage.
Collapse
Affiliation(s)
- Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | | | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
- Clinic of Internal and Emergency Medicine, Department of Emergency and Trauma Care, Aalborg, Denmark
| | - Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
5
|
Fadil Azim DH, Mohd Ghazi A, Ong SH, Abdul Majid HS, Morgan K, Hickey A. Improving physical and psychological outcomes of cardiac patients using the Naluri app: A study protocol for a randomized controlled trial. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13629.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Coronary artery disease (CAD) continues to be a significant burden to public health. Poor treatment and management can lead to more severe cardiac events that could result in death or disability. Early interventions like cardiac rehabilitation programs can provide patients the required knowledge, skills and support to recover from and prevent more cardiac events. Electronic health (eHealth) interventions have potential to complement hospital-based rehabilitation programs. This study aims to investigate the effectiveness of the Naluri app in improving health behaviours, clinical and psychological outcomes in a sample of cardiac patients in Malaysia. Methods: This study is a two-arm, parallel, superiority randomized control trial to be conducted at the Malaysian National Heart Institute. A total of 200 patients will be randomly assigned to either a 16-week theory-based Naluri app in addition to usual care (treatment) or to usual care only (control). Outcomes will be measured at baseline and at 16 weeks. Health behaviour outcomes include physical activity and diet. Clinical outcomes include BMI, hemoglobin A1c (HbA1c), and lipid levels. Psychological outcomes include anxiety, depression, and health related quality of life (HRQOL). The Naluri app theoretical framework is based on the Health Action Process Approach (HAPA) theory. Risk perception, self-efficacy, planning, intentions, outcome expectancies, illness perceptions and psychological outcomes will be measured using self-reported measures. Discussion: This trial will determine the effectiveness of the Naluri app intervention in improving various outcomes of cardiac patients after four months. It will provide data on the applicability of the HAPA theory in Mobile health (mHealth) intervention and the acceptance and efficacy of mHealth as a cardiac rehabilitation program for patients in Malaysia. The results may inform the potential implementation of the app for use with patients with other chronic illnesses like diabetes, stroke, and depression. Registration: Australia New Zealand Clinical Trials Registry (14/01/2019, ACTRN12619000104156).
Collapse
|
6
|
Mourad G, Eriksson-Liebon M, Karlström P, Johansson P. The Effect of Internet-Delivered Cognitive Behavioral Therapy Versus Psychoeducation Only on Psychological Distress in Patients With Noncardiac Chest Pain: Randomized Controlled Trial. J Med Internet Res 2022; 24:e31674. [PMID: 35089153 PMCID: PMC8838599 DOI: 10.2196/31674] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/09/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023] Open
Abstract
Background Patients with recurrent episodes of noncardiac chest pain (NCCP) experience cardiac anxiety as they misinterpret the pain to be cardiac related and avoid physical activity that they think could threaten their lives. Psychological interventions, such as internet-delivered cognitive behavioral therapy (iCBT), targeting anxiety can be a feasible solution by supporting patients to learn how to perceive and handle their chest pain. Objective This study aims to evaluate the effects of a nurse-led iCBT program on cardiac anxiety and other patient-reported outcomes in patients with NCCP. Methods Patients with at least two health care consultations because of NCCP during the past 6 months, and who were experiencing cardiac anxiety (Cardiac Anxiety Questionnaire score ≥24), were randomized into 5 weeks of iCBT (n=54) or psychoeducation (n=55). Patients were aged 54 (SD 17) years versus 57 (SD 16) years and were mainly women (32/54, 59% vs 35/55, 64%). The iCBT program comprised psychoeducation, mindfulness, and exposure to physical activity, with weekly homework assignments. The primary outcome was cardiac anxiety. The secondary outcomes were fear of bodily sensations, depressive symptoms, health-related quality of life, and chest pain frequency. Intention-to-treat analysis was applied, and the patients were followed up for 3 months. Mixed model analysis was used to determine between-group differences in primary and secondary outcomes. Results No significant differences were found between the iCBT and psychoeducation groups regarding cardiac anxiety or any of the secondary outcomes in terms of the interaction effect of time and group over the 3-month follow-up. iCBT demonstrated a small effect size on cardiac anxiety (Cohen d=0.31). In the iCBT group, 36% (16/44) of patients reported a positive reliable change score (≥11 points on the Cardiac Anxiety Questionnaire), and thus an improvement in cardiac anxiety, compared with 27% of (13/48) patients in the psychoeducation group. Within-group analysis showed further significant improvement in cardiac anxiety (P=.04) at the 3-month follow-up compared with the 5-week follow-up in the iCBT group but not in the psychoeducation group. Conclusions iCBT was not superior to psychoeducation in decreasing cardiac anxiety in patients with NCCP. However, iCBT tends to have better long-term effects on psychological distress, including cardiac anxiety, health-related quality of life, and NCCP frequency than psychoeducation. The effects need to be followed up to draw more reliable conclusions. Trial Registration ClinicalTrials.gov NCT03336112; https://www.clinicaltrials.gov/ct2/show/NCT03336112
Collapse
Affiliation(s)
- Ghassan Mourad
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Magda Eriksson-Liebon
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Emergency Medicine in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Patric Karlström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Internal Medicine, Ryhov County Hospital, Region Jönköping County, Jönköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Internal Medicine in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
7
|
Schroeder S, Achenbach S, Martin A. Efficacy of a Psychological Single-Session Intervention in Non-Cardiac Chest Pain. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Abstract. Despite medical reassurance, non-cardiac chest pain (NCCP) frequently persists. Psychological interventions seem promising, but single-session interventions (SSI) are under-studied. To analyze the efficacy of a SSI focusing on chest pain perceptions in a randomized controlled trial (RCT), and to identify predictors of pain persistence. Individuals presenting with NCCP to a cardiology unit were randomly assigned to SSI ( N = 54) or treatment as usual ( N = 59). Follow-up assessments were 1 month (FU1) and 6 months (FU2) later. Primary outcome measures were chest pain (German Pain Questionnaire) and chest pain perceptions (IPQ-B, Reassurance Scale). Two by Three ANOVAs revealed significant improvements over time, but against expectation no significant interaction with group. Health concern and cardiac attribution following cardiac testing predicted FU2 chest pain ( p’s ≤ .018). These predictors could serve as markers to identify individuals with a risk for persisting complaints, a group that may benefit from interventions addressing dysfunctional illness perceptions.
Collapse
Affiliation(s)
- Stefanie Schroeder
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Alexandra Martin
- Department of Clinical Psychology and Psychotherapy, University of Wuppertal, Germany
| |
Collapse
|
8
|
Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital. Glob Heart 2020; 15:9. [PMID: 32489782 PMCID: PMC7218785 DOI: 10.5334/gh.402] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Acute coronary syndrome (ACS) is thought to be a rare diagnosis in sub-Saharan Africa, but little is known about diagnostic practices for patients with possible ACS symptoms in the region. Objective To describe current care practices for patients with ACS symptoms in Tanzania to identify factors that may contribute to ACS under-detection. Methods Emergency department patients with chest pain or shortness of breath at a Tanzanian referral hospital were prospectively observed. Medical histories were obtained, and diagnostic workups, treatments, and diagnoses were recorded. Five-year risk of cardiovascular events was calculated via the Harvard National Health and Nutrition Examination Survey risk score. Telephone follow-ups were conducted 30 days after enrollment. Results Of 339 enrolled patients, the median (IQR) age was 60 (46, 72) years, 252 (74.3%) had hypertension, and 222 (65.5%) had >10% five-year risk of cardiovascular event. The median duration of symptoms prior to presentation was 7 days, and 314 (92.6%) reported symptoms worsened by exertion. Of participants, 170 (50.1%) received an electrocardiogram, and 9 (2.7%) underwent cardiac biomarker testing. There was no univariate association between five-year cardiovascular risk and decision to obtain an electrocardiogram (p = 0.595). The most common physician-documented diagnoses were symptomatic hypertension (104 patients, 30.7%) and heart failure (99 patients, 29.2%). Six patients (1.8%) were diagnosed with ACS, and 3 (0.9%) received aspirin. Among 284 (83.8%) patients completing 30-day follow-up, 20 (7.0%) had died. Conclusions Many patients with ACS risk factors present to the emergency department of a Tanzanian referral hospital with possible ACS symptoms, but marked delays in care-seeking are common. Complete diagnostic workups for ACS are uncommon, ACS is rarely diagnosed or treated with evidence-based therapies, and mortality in patients with these symptoms is high. Physician practices may be contributing to ACS under-detection in Tanzania, and interventions are needed to improve ACS care.
Collapse
|
9
|
Egeland GM, Akerkar R, Kvåle R, Sulo G, Tell GS, Bakken IJ, Ebbing M. Hospitalised patients with unexplained chest pain: incidence and prognosis. J Intern Med 2019; 286:562-572. [PMID: 31322304 DOI: 10.1111/joim.12948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The prognosis of unexplained chest pain patients provides valuable information for evaluation of health services. OBJECTIVE To examine prognosis of unexplained chest pain. METHODS Using data from in- and outpatient hospital visits in Norway of patients discharged with a main diagnosis of unexplained chest pain (ICD-10: R072-R074) in 2010-2012, the 1-year incidence of coronary heart disease (CHD), any cardio-vascular disease (CVD) and mortality was evaluated. Cases with prior 2-year history of CVD or chest pain were excluded. Cox proportional hazards evaluated outcomes by patient characteristics and standardized mortality ratios evaluated observed versus expected mortality. RESULTS Of 59 569 patients identified (20-89 years of age), the majority (86%) were referred to hospital by out-of-hours emergency care centres. Subsequent CHD was noted for 12.5%, 19.5% and 25.0% of men and 7.2%, 11.0%, 14.0% of women aged 45-64, 65-74 and 75-89 years, respectively. The per cent of deaths attributed to CVD were greatest within the first 2 months of postdischarge. Total mortality rates (per 1000 person-years) were 6.6 in men and 4.7 in women aged 45-64 and 69.2 in men and 39.5 in women aged 75-89 years. Relative to the general population, mortality was 53% and 45% higher for men and women under 65 years of age, respectively, attributed primarily to non-CVD causes. CONCLUSION Patients in Norway discharged with unexplained chest pain are an at-risk group in terms of incident CHD, any CVD and mortality, including non-CVD mortality during the first-year postdischarge. The results suggest that unexplained chest pain patients may benefit from greater healthcare coordination between medical disciplines.
Collapse
Affiliation(s)
- G M Egeland
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - R Akerkar
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway
| | - R Kvåle
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway.,Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - G Sulo
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - G S Tell
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - I J Bakken
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - M Ebbing
- Department for Research and Development, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
10
|
Pedersen CK, Stengaard C, Friesgaard K, Dodt KK, Søndergaard HM, Terkelsen CJ, Bøtker MT. Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2019; 27:84. [PMID: 31464622 PMCID: PMC6716930 DOI: 10.1186/s13049-019-0659-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/14/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chest pain is common in acute ambulance transports. This study aims to characterize and compare ambulance-transported chest pain patients to non-chest pain patients and evaluate if patient characteristics and accompanying symptoms accessible at the time of emergency call can predict cause and outcome in chest pain patients. METHODS Retrospective, observational population-based study, including acute ambulance transports. Patient characteristics and symptoms are included in a multivariable risk model to identify characteristics, associated with being discharged without an acute cardiac diagnosis and surviving 30 days after chest pain event. RESULTS In total, 10,033 of 61,088 (16.4%) acute ambulance transports were due to chest pain. In chest pain patients, 30-day mortality was 2.1% (95%CI 1.8-2.4) compared to 6.0% (95%CI 5.7-6.2) in non-chest pain patients. Of chest pain patients, 1054 (10.5%) were diagnosed with acute myocardial infarction, and 5068 (50.5%) were discharged without any diagnosis of disease. This no-diagnosis group had very low 30-day mortality, 0.4% (95%CI 0.2-0.9). Female gender, younger age, chronic pulmonary disease, absence of accompanying symptoms of dyspnoea, radiation, severe pain for > 5 min, clammy skin, uncomfortable, and nausea were associated with being discharged without an acute cardiac diagnosis and surviving 30 days after a chest pain event. CONCLUSION Chest pain is a common reason for ambulance transport, but the majority of patients are discharged without a diagnosis and with a high survival rate. Early risk prediction seems to hold a potential for resource downgrading and thus cost-saving in selected chest pain patients.
Collapse
Affiliation(s)
- Claus Kjær Pedersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Carsten Stengaard
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kristian Friesgaard
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.,Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Karen Kaae Dodt
- Department of Internal Medicine, Regional Hospital Horsens, Horsens, Denmark
| | | | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Morten Thingemann Bøtker
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.,Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| |
Collapse
|
11
|
Sial JA, Khan N, Murad W, Karim M. Burden of Non-cardiac Patients on the Emergency Room of a Rural Cardiac Center in Sindh, Pakistan. Cureus 2018; 10:e3291. [PMID: 30443461 PMCID: PMC6235657 DOI: 10.7759/cureus.3291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The number of cardiac patients increases on a daily basis, and emergency departments bear much of the burden of non-cardiac patients due to pathological fears of the aftermath of the disease. Therefore, this study aimed to determine the burden of non-cardiac patients on the emergency department of a cardiac center in a rural area of Sindh, Pakistan. Methods This cross-sectional study was conducted at the emergency department of Chandka Medical College Hospital in Larkana. Consecutive patients who presented with cardiac symptoms with no previous history of cardiac disease were included. After a brief history, physical examination, electrocardiogram, and a cardiac enzyme assessment, patients were categorized as cardiac or non-cardiac. Data were analyzed using IBM SPSS Statistics for Windows, Version 21.0. (IBM Corp., Armonk, NY, US) and p ≤0.05 was statistically significant. Results Of the 204 patients included, 112 (59.8%) were men, and the mean age was 47 ± 16 years. Most patients (n = 146; 71.6%) were diagnosed as non-cardiac. The non-cardiac diagnosis was significantly more common among patients without diabetes (n = 123, 77.4% vs. n = 23, 51.1%; p = 0.001), without chest pains (n = 93, 81.6% vs. n = 53, 58.9%; p< 0.001), and without shortness of breath (n = 107, 75.9% vs. n = 39, 61.9%; p = 0.041). Conclusion More than two-thirds of the patients were found to have a non-cardiac mechanism behind their symptoms. A major proportion of the emergency room's cardiology department is occupied by non-cardiac patients. Owing to its direct and indirect implication on an otherwise struggling health system, we suggest chest pain units should be developed to decrease the workload and provide better care to cardiac patients.
Collapse
Affiliation(s)
- Jawaid A Sial
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Naveedullah Khan
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Waheed Murad
- Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, ARE
| | - Musa Karim
- Research, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| |
Collapse
|
12
|
Abdi S, Sahraie R, Malekpour H, Ashatri S, Jahani-Sherafat S, Iranshahi M, Frootan M. The high frequency of esophageal disorders in Iranian patients with non-cardiac chest pain. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2018; 11:S32-S38. [PMID: 30774805 PMCID: PMC6347990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The aim of this study was to evaluate the prevalence of gastrointestinal disorders in non-cardiac chest pain (NCCP) Iranian patients. BACKGROUND Gastro-esophageal reflux disease (GERD) is the most common cause of NCCP, which accounts for about one third of cases. METHODS This was a descriptive study on consecutive NCCP patients who referred to the gastroenterology clinic at the Taleghani Hospital, Tehran, Iran from 2015 to 2017. Medical history, physical examination and esophageal test including upper gastroenterology (UGI) endoscopy, esophageal manometry and 24 hour ambulatory esophageal pH monitoring were done for each participant. RESULTS The study included 102 patients, of which 58.9% were women, and the mean age of patients was 41.5 ± 11.2 years. The most common symptoms associated with chest pain were regurgitation in 28.4%, dysphagia in 23.5% and heartburn in 19.6% patients. UGI endoscopy was abnormal in 29.4% cases, esophageal manometry was abnormal in 61.7% cases and ambulatory pH monitoring was abnormal in 37.2% patients. Using UGI endoscopy and combined 24-h pH monitoring determined the prevalence of GERD 44.1% , and based on manometry the most frequent causes of NCCP was ineffective esophageal motility (IEM) in 19.6% patients with NCCP. CONCLUSION Detecting etiology of NCCP allows healthcare providers to assure patients of the benign nature of their condition and provide appropriate treatment. It can also help prevent excessive hospital and physician visits as well as the costly and potentially risky testing which often results.
Collapse
Affiliation(s)
- Saeed Abdi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roghayeh Sahraie
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habib Malekpour
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Ashatri
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Somayeh Jahani-Sherafat
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Iranshahi
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Frootan
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|