Journal Article

Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome

Holmberg, Mats, Winge, Karin, Karlsson, Thomas, Andersson, Henrik, Wireklint Sundström, Birgitta, Herlitz, Johan, Lundberg, Camilla

2018

Overview

Background To decrease the morbidity burden of cardiovascular disease and to avoid the development of potentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) are important. The aim of this study has therefore been to explore the possible association between patients’ estimated intensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcome before and after arrival in hospital. Methods Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raising suspicion of ACS and a reported intensity of pain ≥4 on the visual analogue scale. Results All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) more heart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest pain after hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation. However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment for possible confounders including age, a history of smoking and heart failure showed similar results. Conclusion The estimated intensity of chest pain reported by the patients on admission by the ambulance team was associated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospital admission, the final diagnosis and the number of days in hospital. Trial registration ClinicalTrials.gov 151:2008/4564 Identifier: NCT00792181. Registred 17 November 2008 ‘retrospectively registered’.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acute coronary syndrome / Acute Coronary Syndrome - complications / Acute Coronary Syndrome - diagnosis / Acute Coronary Syndrome - mortality / Acute Coronary Syndrome - therapy / Acute coronary syndromes / Aged / Aged, 80 and over / Ambulance care / Ambulance nurse / Ambulances / Angina pectoris / Angina Pectoris - diagnosis / Angina Pectoris - etiology / Angina Pectoris - mortality / Angina Pectoris - therapy / Angiology / Anxiety / Anxiety - diagnosis / Anxiety - etiology / Assessment / Blood Transfusion Medicine / Cardiac Surgery / Cardiology / Cardiovascular disease / Cardiovascular diseases / Care and treatment / Care Sciences / Chest / Chest pain / Clinical Medicine / Coronary artery disease / Early Diagnosis / Electrocardiography / Emergency medical care / Emergency Medical Services / Emergency Medical Technicians / Emergency services / Female / Health aspects / Health Status / Heart attacks / Heart diseases / Heart failure / Heart Failure - diagnosis / Heart Failure - etiology / Hospitals / Humans / Internal Medicine / Klinisk medicin / Length of Stay / Male / Medicine / Medicine & Public Health / Middle Aged / Morbidity / Myocardial infarction / Pain / Pain Measurement / Patient Admission / Patients / Patients ́ experiences / Patients´ experiences / Predictive Value of Tests / Prognosis / Prospective Studies / Research Article / Retrospective Studies / Severity of Illness Index / Smoking / Time Factors / vårdvetenskap