Abstract 12162: Association of Symptom Clusters With Mode of Transportation to Emergency Department in Patients Diagnosed With Acute Coronary Syndrome

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Leslie L Davis ◽  
Thomas P McCoy ◽  
Barbara Riegel ◽  
Sharon McKinley ◽  
Lynn Doering ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Delay Time ◽  
Symptom Clusters ◽  
Prehospital Delay ◽  
Coronary Syndrome ◽  
Stress Symptoms ◽  
Mode Of Transportation

Background: Prompt treatment of acute coronary syndrome (ACS) has been shown to reduce mortality and morbidity; yet many patients delay seeking care. In order to receive timely care, symptoms of ACS need to be recognized, interpreted, and acted upon. Patients who experience symptoms matching their expectations and those with correct symptom attribution are more likely to use emergency medical services (EMS) as a means of transportation to the hospital. The connection between symptom type and EMS use has not been fully explored. Purpose: To assess if clusters of presenting symptoms are associated with EMS transportation to the emergency department (ED) in patients with ACS and to evaluate if EMS transportation or symptom clusters are associated with prehospital delay time. Methods: A secondary analysis was conducted from the PROMOTION trial, a randomized controlled trial to reduce patient prehospital delay in ACS. Results: Of the 3,522 subjects with coronary artery disease enrolled, 3,087 completed 2-year follow-up. Of these, 331 subjects visited an ED for ACS symptoms during follow-up. Among the 331, 84% (278) had mode of transportation documented; 44% arrived by EMS. Having classic ACS symptoms (chest pain, pressure, or discomfort) in combination with pain symptoms (AOR=2.66, p = 0.011), classic ACS symptoms in combination with stress symptoms (AOR=2.61, p = 0.007) or classic ACS symptoms in combination with both pain and stress symptoms (AOR=3.90, p = 0.012) were associated with higher odds of arriving to the ED by EMS compared to classic ACS symptoms alone. Among 260 patients with prehospital delay time available, arriving by EMS decreased median delay time by 68.5 minutes compared to those with other transportation, after accounting for symptom clusters, patient and study characteristics (p = 0.002). Symptom clusters did not predict delay time in adjusted modeling (p = 0.952). Conclusion: While chest pain was the most prevalent symptom of ACS for most (85%), these findings suggest that it is the cluster of classic ACS symptoms with other types of symptom that motivate patients to use EMS. With less than half of patients using EMS, further research is needed to better understand how symptom clusters influence care-seeking behavior.

Abstract 13550: Understanding Associations of Hospital Admission or Observation With Patient Outcomes After Emergency Department Evaluation for Suspected Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Adam L Sharp ◽  
Aniket A Kawatkar ◽  
Aileen S Baecker ◽  
Rita F Redberg ◽  
Mingsum Lee ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Hospital Admission ◽  
Risk Reduction ◽  
Patient Outcomes ◽  
Coronary Revascularization ◽  
Coronary Syndrome

Introduction: Evaluation for suspected acute coronary syndrome (ACS) results in millions of emergency department (ED) visits annually, and accounts for billions in health care costs. Understanding the benefits of hospitalization among patients who ruled out for an acute myocardial infarction (AMI) will inform physician decision making and future health care policies. Hypothesis: Hospital admission does not improve 30-day patient outcomes (death/AMI) compared to those discharged after ED evaluation for suspected ACS. Methods: We compared the effectiveness of hospitalization vs outpatient follow-up for a cohort of patients with chest pain presenting to one of 13 EDs within the Kaiser Permanente Southern California region between January 1, 2015 and December 1, 2017. The primary outcome was AMI or all-cause mortality, and secondary outcomes included revascularization and a composite MACE outcome within 30-days of ED visit. Adjusting for patient age, gender, race, ACS risk factors and chronic co-morbidities an instrumental variable (IV) analysis was used to evaluate the effect of hospitalization on patient outcomes Results: Of 77,562 chest pain patient encounters not identified as an AMI during the ED encounter, 322 (0.4%) went on to have an AMI (n=193, 0.2%) or died (n=137, 0.2%) within 30-days of ED visit (1.5% admitted vs 0.2% discharged). This included 200 (0.3%) patients who underwent coronary revascularization (0.7% admitted vs 0.2% discharged). IV analysis found no adjusted differences in 30-day patient outcomes between the hospitalized cohort and those discharged (risk reduction 0.002, 95% CI -0.002 to 0.007). Similarly, there were no differences in coronary revascularization (risk reduction 0.003, 95% CI -0.002 to 0.007). Conclusions: Among ED patients with chest pain who are not identified with an AMI, there does not appear to be a benefit in 30-day outcomes for patients who are hospitalized compared to those discharged with outpatient follow-up.

Abstract 13173: Unusual Fatigue and Failure to Utilize Emergency Medical Services Are Associated With Prolonged Prehospital Delay for Suspected Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Holli A Devon ◽  
Mohamud R Daya ◽  
Elizabeth Knight ◽  
Mary-Lynn Brecht ◽  
Erica Su ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Delay Time ◽  
Failure Time ◽  
Secondary Analysis ◽  
High Sensitivity ◽  
Final Diagnosis ◽  
Prehospital Delay ◽  
Coronary Syndrome ◽  
Risk Patients

Introduction: Rapid reperfusion reduces infarct size and mortality for acute coronary syndrome (ACS) but efficacy is time dependent. Time to presentation in the Emergency Department (ED) remains excessive and patient-controlled prehospital delay may be a modifiable variable for intervention. The aim of the study was to determine if transportation factors and clinical presentation predicted prehospital delay for suspected ACS stratified by final diagnosis (ACS vs. no ACS). Hypothesis: Symptoms other than chest pain would contribute to longer prehospital delay that would vary by final diagnosis. Methods: Secondary analysis of data collected from a multi-center prospective study. A heterogeneous sample of ED patients with symptoms suggestive of ACS were enrolled at five sites in the US. Accelerated failure time (AFT) models were used to specify a direct relationship between delay time and variables to predict prehospital delay by final diagnosis. Results: The sample of 975 adults included 609 (62.5%) men and 366 (37.5%) women who were predominantly Caucasian (69.1%), had a mean age of 60.32 (±14.07) years, and had lower income levels (66.4% ≤$50,000 annually). Median delay time was 6.68 (1.91, 24.94) hours and only 26.2% had a prehospital delay of 2 hours or less. Patients with and without ACS presenting with unusual fatigue (TR=1.71, p=0.002; TR=1.54, p=0.003 , respectively) or self-transporting to the ED experienced significantly longer prehospital delay (TR 1.93, p<0.001; TR 1.71, p<0.001 , respectively). Predictors of shorter delay in patients with ACS were shoulder pain and lightheadedness (TR=0.65, p =0.013 and TR=0.67, p =0.022, respectively). Predictors of shorter delay for patients ruled-out for ACS were the presence of chest pain, sweating (TR=0.071, p =0.025 and TR=0.073, p =0.032, respectively). Conclusion: Patients self-transporting to the ED had prolonged prehospital delays. Encouraging the use of EMS is an important modifiable factor for patients with symptoms concerning for ACS. Calling 911 can be positively framed to at risk patients and the community as having advanced care come to them since EMS diagnostic capabilities include 12-lead ECG acquisition and possibly high sensitivity troponin assays.

scholarly journals THE CORRELATION OF HEALTH SEEKING BEHAVIOR AND TRANSPORTATION MODE WITH PREHOSPITAL DELAY TIME IN PATIENTS WITH ACUTE CORONARY SYNDROME AT EMERGENCY DEPARTMENT OF REGIONAL PUBLIC HOSPITAL OF dr. T.C. HILLERS

2017 ◽  
Vol 2 (2) ◽  
pp. 87
Author(s):  
Ode Irman ◽  
Sri Poeranto ◽  
Tony Suharsono
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Delay Time ◽  
Public Hospital ◽  
Health Seeking ◽  
Transportation Mode ◽  
Health Seeking Behavior ◽  
Prehospital Delay ◽  
Coronary Syndrome ◽  
Seeking Behavior

Emergency conditions of the acute coronary syndrome (ACS) requires rapid and precise management. Prehospital delay time can result in deaths attributed to health seeking behavior and transportation mode. This research aimed to analyze the correlation of health seeking behavior and transportation mode with prehospital delay time in patients with Acute Coronary Syndrome at Emergency Department of Regional Public Hospital of dr. T.C. Hillers. The research design was observational analytic with cross sectional approach. The sample was 42 respondents obtained by using consecutive sampling. Data were collected with an interview in April-June 2017, then analyzed with univariate analysis and bivariate (Fisher test). The results showed that the majority of health seeking behavior of ACS patients was delayed to hospital (76.2%) and the mode of transportation used was public transportation (31%). Prehospital delay time most of which arrived late (> 120 min) (61.9%). Result of fisher test show there is correlation of health seeking behavior and transportation mode with prehospital delay time in patients with Acute Coronary Syndrome at Emergency Department of Regional Public Hospital of dr. T.C. Hillers. The results indicate the importance of improving patient referral systems, provide health counseling, provide village ambulances, support and organize Emergency Medical Services.

Prediction of Troponin elevation in Non- ST Acute Coronary Syndrome Patients presenting to The Emergency Department Using Neutrophil-lymphocyte ratio

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sarah Mohamed Mahmoud ◽  
Bassam Sobhy ◽  
Ramy Raymond
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Complete Blood Count ◽  
P Value ◽  
Troponin Elevation ◽  
Positive Group ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Coronary Syndrome

Abstract Background The neutrophil–lymphocyte ratio (NLR) is considered an independent predictor of mortality and myocardial infarction (MI) in stable coronary artery disease (SCAD). Also NLR have prognostic value in patients with acute coronary syndromes (ACSs). However the diagnostic power of NLR in patients suspected of ACS is still under study Objective is to determine the ability of neutrophil-lymphocyte ratio to predict troponin elevation in patients presenting to emergency department with acute coronary syndrome Material and Methods From June 2018 to March 2019, 100 patients were enrolled who presented to the ER with NST-ACS. Patients were divided into 2 groups based upon the troponin positivity in the 12- to 24-hour follow-up. Baseline Complete blood count with calculation of NLR is done Results The study population was divided into 2 groups: troponin- negative group (n = 50) and troponin-positive group (n = 50). Mean age was 55.8 ± 11.3. 77% of the patients were male. No significance difference in the level of hemoglobin, WBCs and platelets between the 2 groups. The neutrophil count was significantly higher in the troponin-positive group (p &lt; 0.001). The median admission. NLR was significantly higher in the troponin-positive group (2 vs. 3.9, P &lt; 0.001). A cutoff point of 3.4 for NLR measured on admission had 84% sensitivity and 84% specificity in predicting follow-up troponin positivity. A highly significant correlation was found between NLR and level of troponin change (p value &lt;0.01) Conclusion NLR can be used as a diagnostic tool in the differentiation of patients with acute coronary syndrome. NLR is a non-expensive, simple and available parameter that can be used in diagnosis of NSTEMI.

Frequency of acute coronary syndrome in patients presenting to the Emergency Department with chest pain after methamphetamine use

2003 ◽  
Vol 24 (4) ◽  
pp. 369-373 ◽  
Author(s):  
Samuel D Turnipseed ◽  
John R Richards ◽  
J.Douglas Kirk ◽  
Deborah B Diercks ◽  
Ezra A Amsterdam
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Methamphetamine Use ◽  
Coronary Syndrome

Novel Emergency Department Risk Score Discriminates Acute Coronary Syndrome Among Chest Pain Patients With Known Coronary Artery Disease

2016 ◽  
Vol 15 (4) ◽  
pp. 138-144 ◽  
Author(s):  
Matthew T. Crim ◽  
Scott A. Berkowitz ◽  
Mustapha Saheed ◽  
Jason Miller ◽  
Amy Deutschendorf ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Coronary Artery ◽  
Risk Score ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Pain Patients

scholarly journals External validation of an emergency department triage algorithm for chest pain patients

2020 ◽  
Vol 9 (6) ◽  
pp. 576-585
Author(s):  
Òscar Miró ◽  
Pedro Lopez-Ayala ◽  
Gemma Martínez-Nadal ◽  
Valentina Troester ◽  
Ivo Strebel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Low Risk ◽  
Single Centre ◽  
Coronary Syndrome ◽  
Emergency Department Triage ◽  
Model C ◽  
Triage Algorithm ◽  
Pain Patients

Background We aimed to externally validate an emergency department triage algorithm including five hierarchical clinical variables developed to identify chest pain patients at low risk of having an acute coronary syndrome justifying delayed rather than immediate evaluation. Methods In a single-centre cohort enrolling 29,269 consecutive patients presenting with chest pain, the performance of the algorithm was compared against the emergency department discharge diagnosis. In an international multicentre study enrolling 4069 patients, central adjudication by two independent cardiologists using all data derived from cardiac work-up including follow-up served as the reference. Triage towards ‘low-risk’ required absence of all five clinical ‘high-risk’ variables: history of coronary artery disease, diabetes, pressure-like chest pain, retrosternal chest pain and age above 40 years. Safety (sensitivity and negative predictive value (NPV)) and efficacy (percentage of patients classified as low risk) was tested in this initial proposal (Model A) and in two additional models: omitting age criteria (Model B) and allowing up to one (any) of the five high-risk variables (Model C). Results The prevalence of acute coronary syndrome was 9.4% in the single-centre and 28.4% in the multicentre study. The triage algorithm had very high sensitivity/NPV in both cohorts (99.4%/99.1% and 99.9%/99.1%, respectively), but very low efficacy (6.2% and 2.7%, respectively). Model B resulted in sensitivity/NPV of 97.5%/98.3% and 96.1%/89.4%, while efficacy increased to 14.2% and 10.4%, respectively. Model C resulted in sensitivity/NPV of 96.7%/98.6% and 95.2%/91.3%, with a further increase in efficacy to 23.1% and 15.5%, respectively. Conclusion A triage algorithm for the identification of low-risk chest pain patients exclusively based on simple clinical variables provided reasonable performance characteristics possibly justifying delayed rather than immediate evaluation in the emergency department.

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