‘Chest Pain Typicality’ in Suspected Acute Coronary Syndromes and the Impact of Clinical Experience

Abstract Background Patients with acute coronary syndromes often experience non-specific (generic) pain after hospital discharge. However, evidence about the association between post-discharge non-specific pain and rehospitalization remains limited. Methods We analyzed data from the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) prospective cohort. TRACE-CORE followed patients with acute coronary syndromes for 24 months post-discharge from the index hospitalization, collected patient-reported generic pain (using SF-36) and chest pain (using the Seattle Angina Questionnaire) and rehospitalization events. We assessed the association between generic pain and 30-day rehospitalization using multivariable logistic regression (N = 787). We also examined the associations among patient-reported pain, pain documentation identified by natural language processing (NLP) from electronic health record (EHR) notes, and the outcome. Results Patients were 62 years old (SD = 11.4), with 5.1% Black or Hispanic individuals and 29.9% women. Within 30 days post-discharge, 87 (11.1%) patients were re-hospitalized. Patient-reported mild-to-moderate pain, without EHR documentation, was associated with 30-day rehospitalization (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.14–3.62, reference: no pain) after adjusting for baseline characteristics; while patient-reported mild-to-moderate pain with EHR documentation (presumably addressed) was not (OR: 1.23, 95% CI: 0.52–2.90). Severe pain was also associated with 30-day rehospitalization (OR: 3.16, 95% CI: 1.32–7.54), even after further adjusting for chest pain (OR: 2.59, 95% CI: 1.06–6.35). Conclusions Patient-reported post-discharge generic pain was positively associated with 30-day rehospitalization. Future studies should further disentangle the impact of cardiac and non-cardiac pain on rehospitalization and develop strategies to support the timely management of post-discharge pain by healthcare providers.

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117 Oral A long term evaluation study of the impact of a nurse-led early triage service for chest pain patients, aimed at improving the management of those with non ST-elevation acute coronary syndromes

European Journal of Cardiovascular Nursing ◽

10.1016/s1474-51511160034-0 ◽

2011 ◽

Vol 10 (1_suppl) ◽

pp. 6-7

Author(s):

L. O’Neill ◽

P.F. Currie ◽

C.C. Lang

Keyword(s):

Chest Pain ◽

Acute Coronary Syndromes ◽

Evaluation Study ◽

Coronary Syndromes ◽

Term Evaluation ◽

St Elevation ◽

The Impact ◽

Pain Patients

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Physical fitness cannot be used to predict the likelihood of acute coronary syndromes in ED patients with chest pain

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2010.07.027 ◽

2012 ◽

Vol 30 (1) ◽

pp. 57-60

Author(s):

Taku Taira ◽

Breena R. Taira ◽

Jasmine Chohan ◽

Daniel Dickinson ◽

Regina M. Troxell ◽

...

Keyword(s):

Chest Pain ◽

Physical Fitness ◽

Acute Coronary Syndromes ◽

Coronary Syndromes

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Chronic kidney disease as a risk factor for acute coronary syndromes in patients presenting to the emergency room with chest pain

Translational Research ◽

10.1016/j.trsl.2011.12.006 ◽

2012 ◽

Vol 159 (5) ◽

pp. 391-396 ◽

Cited By ~ 5

Author(s):

Sherezade Khambatta ◽

Michael E. Farkouh ◽

R. Scott Wright ◽

Guy S. Reeder ◽

Peter A. McCullough ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Risk Factor ◽

Chest Pain ◽

Kidney Disease ◽

Emergency Room ◽

Acute Coronary Syndromes ◽

Coronary Syndromes

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PRe-hospital Evaluation of Sensitive TrOponin (PRESTO) Study: multicentre prospective diagnostic accuracy study protocol

BMJ Open ◽

10.1136/bmjopen-2019-032834 ◽

2019 ◽

Vol 9 (10) ◽

pp. e032834 ◽

Cited By ~ 3

Author(s):

Abdulrhman Alghamdi ◽

Eloïse Cook ◽

Edward Carlton ◽

Aloysius Siriwardena ◽

Mark Hann ◽

...

Keyword(s):

Chest Pain ◽

Hospital Admission ◽

Diagnostic Accuracy ◽

Blood Sample ◽

Acute Coronary Syndromes ◽

Venous Blood ◽

Prehospital Setting ◽

Registration Number ◽

Coronary Syndromes ◽

Rule Out

IntroductionWithin the UK, chest pain is one of the most common reasons for emergency (999) ambulance calls and the most common reason for emergency hospital admission. Diagnosing acute coronary syndromes (ACS) in a patient with chest pain in the prehospital setting by a paramedic is challenging. The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision rule is a validated tool used in the emergency department (ED) to stratify patients with suspected ACS following a single blood test.We are seeking to evaluate the diagnostic accuracy of the T-MACS decision aid algorithm to ‘rule out’ ACS when used in the prehospital environment with point-of-care troponin assays. If successful, this could allow paramedics to immediately rule out ACS for patients in the ‘very low risk’ group and avoid the need for transport to the ED, while also risk stratifying other patients using a single blood sample taken in the prehospital setting.Methods and analysisWe will recruit patients who call emergency (999) ambulance services where the responding paramedic suspects cardiac chest pain. The data required to apply T-MACS will be prospectively recorded by paramedics who are responding to each patient. Paramedics will be required to draw a venous blood sample at the time of arrival to the patient. Blood samples will later be tested in batches for cardiac troponin, using commercially available troponin assays. The primary outcome will be a diagnosis of acute myocardial infarction, established at the time of initial hospital admission. The secondary outcomes will include any major adverse cardiac events within 30 days of enrolment.Ethics and disseminationThe study obtained approval from the National Research Ethics Service (reference: 18/ES/0101) and the Health Research Authority. We will publish our findings in a high impact general medical journal.Trial registration numberRegistration number: ClinicalTrials.gov, study ID: NCT03561051

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