scholarly journals Unexpected high level of severe events even in low-risk profile chest pain unit patients

Herz ◽  
2021 ◽  
Author(s):  
Frank Breuckmann ◽  
Stephan Settelmeier ◽  
Tienush Rassaf ◽  
Matthias Hochadel ◽  
Bernd Nowak ◽  
...  
Keyword(s):  
Chest Pain ◽  
Critical Time ◽  
Multivariate Regression Analysis ◽  
Risk Profile ◽  
Study Data ◽  
Low Risk ◽  
Cardiac Symptoms ◽  
First Onset ◽  
High Level ◽  
Event Rates

Abstract Aims Early heart attack awareness programs are thought to increase efficacy of chest pain units (CPU) by providing live-saving information to the community. We hypothesized that self-referral might be a feasible alternative to activation of emergency medical services (EMS) in selected chest pain patients with a specific low-risk profile. Methods and results In this observational registry-based study, data from 4743 CPU patients were analyzed for differences between those with or without severe or fatal prehospital or in-unit events (out-of-hospital cardiac arrest and/or in-unit death, resuscitation or ventricular tachycardia). In order to identify a low-risk subset in which early self-referral might be recommended to reduce prehospital critical time intervals, the Global Registry of Acute Coronary Events (GRACE) score for in-hospital mortality and a specific low-risk CPU score developed from the data by multivariate regression analysis were applied and corresponding event rates were calculated. Male gender, cardiac symptoms other than chest pain, first onset of symptoms and a history of myocardial infarction, heart failure or cardioverter defibrillator implantation increased propensity for critical events. Event rates within the low-risk subsets varied from 0.5–2.8%. Those patients with preinfarction angina experienced fewer events. Conclusions When educating patients and the general population about angina pectoris symptoms and early admission, activation of EMS remains recommended. Even in patients without any CPU-specific risk factor, self-referral bears the risk of severe or fatal pre- or in-unit events of 0.6%. However, admission should not be delayed, and self-referral might be feasible in patients with previous symptoms of preinfarction angina.

scholarly journals Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands

2021 ◽  
Vol 29 (4) ◽  
pp. 224-229 ◽  
Author(s):  
E. R. de Koning ◽  
M. J. Boogers ◽  
J. Bosch ◽  
M. de Visser ◽  
M. J. Schalij ◽  
...  
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Cardiac Symptoms ◽  
Emergency Medical ◽  
Time Period ◽  
Number Of Patients ◽  
St Elevation ◽  
Pain Patients ◽  
Hospital Cardiac Arrest

Abstract Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81–0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32–0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83–1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

Measuring Patient Tolerance for Future Adverse Events in Low-Risk Emergency Department Chest Pain Patients

2014 ◽  
Vol 64 (2) ◽  
pp. 127-136.e3 ◽  
Author(s):  
Jennifer C. Chen ◽  
Richelle J. Cooper ◽  
Ana Lopez-O'Sullivan ◽  
David L. Schriger
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Adverse Events ◽  
Low Risk ◽  
Patient Tolerance ◽  
Pain Patients

Guidelines for reasonable and appropriate care in the emergency department (GRACE): Recurrent, low‐risk chest pain in the emergency department

2021 ◽  
Author(s):  
Paul I. Musey ◽  
Fernanda Bellolio ◽  
Suneel Upadhye ◽  
Anna Marie Chang ◽  
Deborah B. Diercks ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Low Risk ◽  
Appropriate Care

Pitfalls in Evaluating the Low-Risk Chest Pain Patient

2010 ◽  
Vol 28 (1) ◽  
pp. 183-201 ◽  
Author(s):  
Ian D. Jones ◽  
Corey M. Slovis
Keyword(s):  
Chest Pain ◽  
Low Risk ◽  
Pain Patient ◽  
Chest Pain Patient

Acute chest pain — identification of patients at low risk for coronary events. The impact of symptoms, medical history and risk factors

2004 ◽  
Vol 116 (3) ◽  
pp. 83-89 ◽  
Author(s):  
Martin Schillinger ◽  
Gottfried Sodeck ◽  
Giora Meron ◽  
Karin Janata ◽  
Mariam Nikfardjam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
Medical History ◽  
Acute Chest Pain ◽  
Low Risk ◽  
Coronary Events ◽  
The Impact

Study Behaviors and Their Relationships to Test Anxiety and Academic Performance

1972 ◽  
Vol 30 (2) ◽  
pp. 407-410 ◽  
Author(s):  
George J. Allen ◽  
Wayne M. Lerner ◽  
James J. Hinrichsen
Keyword(s):  
Academic Performance ◽  
Test Anxiety ◽  
Multivariate Regression Analysis ◽  
Study Data ◽  
Self Report ◽  
Grade Point ◽  
Academic Aptitude ◽  
Relevant Variables ◽  
Study Behaviors ◽  
High School Rank

Multivariate regression analysis of academic aptitude, test anxiety, and self-report study data from 122 undergraduates indicated high school rank to be the best predictor of grade point average. The number of days Ss reported studying and one test anxiety scale also added significantly to the prediction. Analysis of the study-relevant variables across the semester indicated differential patterns of study existed for students with good, average, and poor grades. The relative independence of test anxiety and study behaviors suggested that the latter class of variables might profitably be used to increase prediction of academic performance.

Cardiac markers in the low-risk chest pain patient

2006 ◽  
Vol 1 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Scott G. Weiner ◽  
Shamai A. Grossman
Keyword(s):  
Chest Pain ◽  
Low Risk ◽  
Pain Patient ◽  
Cardiac Markers ◽  
Chest Pain Patient

Abstract 363: Chest Pain Observation Unit: Does Post-Discharge Stress Testing Influence Physician Management Decisions?

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Yasser Khalil ◽  
Martin E Matsumura ◽  
Maida Abdul-Latif ◽  
Prasant Pandey ◽  
Melvin Schwartz
Keyword(s):  
Chest Pain ◽  
Risk Stratification ◽  
Stress Testing ◽  
Stress Test ◽  
Multivariate Regression Analysis ◽  
The United States ◽  
Observation Unit ◽  
Management Decisions ◽  
Post Discharge ◽  
Effective Manner

Background: Chest pain (CP) accounts for approximately 6 million emergency visits per year in the United States. There is growing interest in strategies to effectively risk stratify pts for coronary artery disease (CAD) related events in a cost-effective manner. The use of chest pain observation units followed by early stress testing is frequently employed in these pts. However the utility of stress testing in this population is not well defined, and the effect of stress test results on subsequent management decisions is a topic of controversy. In the present study we examined the relationship of stress myocardial perfusion imaging (MPI) results to physician decisions regarding ccath in a single community teaching hospital. Methods: Retrospective study of 426 pts undergoing a chest pain observation strategy over a 24 month period. Pt eligible for the program had CP deemed possibly related to CAD but no diagnostic ECG changes and negative TnI measurements x2. All pts underwent outpt. stress MPI within 72 hours of discharge. Pts saw a cardiologist the day of stress MPI who reviewed the CP history, MPI results, and made decisions regarding further risk stratification. Demographic and medical history was collected from the pts chest pain observation unit record. Multivariate regression analysis was used to determine significant independent variables related to physician decisions regarding further risk stratification. Results: Of 426 pts who underwent outpt stress MPI, 71(16.7%) were positive for ischemia, and 16 (22.5% of +MPI) underwent cath with reperfusion performed in 8 (5PCI, 3 CABG, 11.3% of +MPI). Of the 355 pts with negative stress MPI, 5(1.4% of -MPI) underwent cath with reperfusion performed in 2 (2PCI, 0 CABG, 0.5% of -MPI). A MLR model suggested only stress MPI results were independently predictive of the use of ccath for risk stratification. Conclusion: Stress MPI was an important factor in physician decision-making regarding the need for ccath in pts managed in a chest pain observation unit. The rate of +MPI and subsequent use of ccath in our institution supports MPI as an appropriate step in risk stratification of low to moderate risk CP pts triaged through a CP observation unit.

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