scholarly journals Nursing Team Training to Use a Flowchart to Care for Patients with Chest Pain

10.3823/2632 ◽  
2021 ◽  
Vol 14 ◽  
Author(s):  
Bruna Carolina Lima ◽  
Regimar Carla Machado ◽  
Ana Lúcia Gargione Galvão Sant`Anna ◽  
Rosângela Claudia Novembre ◽  
Victoria Dorneles Nery ◽  
...  
Keyword(s):  
Chest Pain ◽  
Emergency Care ◽  
Professional Training ◽  
Small Sample ◽  
Coronary Syndrome ◽  
High Prevalence ◽  
Nursing Team ◽  
Prior Application ◽  
Emergency Care Units

Background: chest pain, of multicausal etiology, associated with a cardiac cause or not, is one of the most frequently presented symptoms by patients in Emergency Care Units. Despite its high prevalence in health services, there is still a deficiency in care standardization, which raises difficulties in acute coronary syndrome diagnosis and delay in treatment. The objective was to assess the efficiency of professional training of nursing teams in Emergency Care Units on the use of a flowchart to care for patients with chest pain. Methods and Findings: this educational intervention study was conducted with 25 nursing team professionals. It has been developed in four steps: Step 1 referred to prior application of the validated research instrument. Step 2 comprised training to use the flowchart with an expository lesson on care of patients with chest pain and guidance regarding the flowchart to be implemented. Step 3 reapplied the validated instrument after class. Step 4 reapplied the instrument after 2 months of training for flowchart implementation. When comparing the results of the instrument applied to nursing team professionals, post-training and follow-up performance surpassed that of pre-training. It was observed that professionals with less than five years of experience showed better performance. This study had as limitation the small sample of health professionals participating in the offered training. Conclusion: training was satisfactory and significant, and professionals demonstrated content assimilation, obtaining higher scores than at the beginning of the research.

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 2004: Usefulness of Coronary CT Angiography in the Early Triage of Patients with Acute Chest Pain

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Udo Hoffmann ◽  
Fabian Bamberg ◽  
Claudia U Chae ◽  
Ian S Rogers ◽  
Sujith K Seneviratne ◽  
...  
Keyword(s):  
Chest Pain ◽  
Hospital Admission ◽  
Acute Chest Pain ◽  
Coronary Plaque ◽  
Discriminatory Power ◽  
Coronary Cta ◽  
Coronary Syndrome ◽  
Coronary Ct ◽  
Increased Risk

Background: Early triage of patients with acute chest pain in the emergency department (ED) may be improved by rapid noninvasive assessment of coronary artery disease (CAD) by coronary computed tomography angiography (CTA). We sought to determine the usefulness of coronary CTA for the early triage of patients with acute chest pain but an inconclusive initial ED evaluation. Methods: Single center, double-blinded observational cohort study in the ED of a large tertiary academic hospital enrolling 368 consecutive patients with acute chest pain and inconclusive initial ED evaluation (normal initial troponin and an initial ECG without evidence of myocardial ischemia) who were awaiting hospital admission between May 2005 and May 2007. All patients underwent 64-slice contrast-enhanced coronary CTA prior to hospital admission with caregivers and patients blinded to the results of the examination. Diagnostic accuracy and discriminatory power of coronary CTA findings (coronary plaque and stenosis [>50% luminal narrowing]) for acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events (MACE) during 6- month follow-up. Results: Among 368 patients (mean age 53±12 years, 61% male) 31 (8%) developed ACS but no MACE occurred during follow-up. Fifty percent (n=183) of the study population had neither plaque nor stenosis, a finding which had 100% negative predictive value (95% confidence interval [CI]: 98 to 100%) for ACS. In adjusted analysis, the extent of coronary plaque and presence of stenosis were associated with an increased risk for ACS (OR: 1.28, 95% CI: 1.14 to 1.43 and OR: 11.69, 95% CI: 4.4 to 31.0; respectively). Coronary CT findings (no CAD, plaque but no stenosis, and stenosis) discriminated patients at low, intermediate, or high risk of ACS (OR: 8.65, 95% CI: 3.69 to 20.26; AUC: 0.91). Conclusion : Half of the patients with acute chest pain and low to intermediate likelihood of ACS have no CAD and may be safely discharged directly from the ED. Coronary CT has excellent discriminatory power in defining patient risk for ACS.

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.

scholarly journals Complement component 7 is associated with total- and cardiac death in chest-pain patients with suspected acute coronary syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Reidun Aarsetøy ◽  
Thor Ueland ◽  
Pål Aukrust ◽  
Annika E. Michelsen ◽  
Ricardo Leon de la Fuente ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cardiac Death ◽  
Complement Component ◽  
Coronary Syndrome ◽  
Norwegian Population ◽  
All Cause Mortality ◽  
Total Death ◽  
Pain Patients

Abstract Background Complement activation has been associated with atherosclerosis, atherosclerotic plaque destabilization and increased risk of cardiovascular events. Complement component 7 (CC7) binds to the C5bC6 complex which is part of the terminal complement complex (TCC/C5b-9). High-sensitivity C-reactive protein (hsCRP) is a sensitive marker of systemic inflammation and may reflect the increased inflammatory state associated with cardiovascular disease. Aim To evaluate the associations between CC7 and total- and cardiac mortality in patients hospitalized with chest-pain of suspected coronary origin, and whether combining CC7 with hsCRP adds prognostic information. Methods Baseline levels of CC7 were related to 60-months survival in a prospective, observational study of 982 patients hospitalized with a suspected acute coronary syndrome (ACS) at 9 hospitals in Salta, Argentina. A cox regression model, adjusting for conventional cardiovascular risk factors, was fitted with all-cause mortality, cardiac death and sudden cardiac death (SCD) as the dependent variables. A similar Norwegian population of 871 patients was applied to test the reproducibility of results in relation to total death. Results At follow-up, 173 patients (17.7%) in the Argentinean cohort had died, of these 92 (9.4%) were classified as cardiac death and 59 (6.0%) as SCD. In the Norwegian population, a total of 254 patients (30%) died. In multivariable analysis, CC7 was significantly associated with 60-months all-cause mortality [hazard ratio (HR) 1.26 (95% confidence interval (CI), 1.07–1.47) and cardiac death [HR 1.28 (95% CI 1.02–1.60)], but not with SCD. CC7 was only weakly correlated with hsCRP (r = 0.10, p = 0.002), and there was no statistically significant interaction between the two biomarkers in relation to outcome. The significant association of CC7 with total death was reproduced in the Norwegian population. Conclusions CC7 was significantly associated with all-cause mortality and cardiac death at 60-months follow-up in chest-pain patients with suspected ACS. Clinical trial registration ClinicalTrials.gov Identifier: NCT01377402, NCT00521976.

scholarly journals Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital

Global Heart ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 9 ◽  
Author(s):  
Julian T. Hertz ◽  
Godfrey L. Kweka ◽  
Gerald S. Bloomfield ◽  
Alexander T. Limkakeng ◽  
Zak Loring ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Emergency Care ◽  
Referral Hospital ◽  
Shortness Of Breath ◽  
Coronary Syndrome

Abstract P069: Prognostic Impact of the Omega-3 Index in Chest Pain Patients With a Suspected Acute Coronary Syndrome and Low Dietary Intake of Omega-3

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Ricardo A Leon de la Fuente ◽  
Patrycja A Naesgaard ◽  
Stein Tore Nilsen ◽  
Torbjoern Aarsland ◽  
Leik Woie ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cardiac Death ◽  
Smoking History ◽  
Dietary Habit ◽  
Prognostic Impact ◽  
Omega 3 ◽  
Cox Regression Analysis ◽  
Coronary Syndrome

Background: Epidemiological and interventional studies suggest that omega-3 (n-3) fatty acids derived from fish oil can reduce the occurrence of cardiovascular disease. Based on these observations, the omega-3 index [eicosapantaenoic acid (EPA) + docosahexaenoic acid (DHA) content in cell red blood membranes] has been suggested as a novel risk marker for cardiac death. Objective: To assess whether the omega-3 index can predict all-cause mortality, cardiac death and sudden cardiac death (SCD) following hospitalization with an acute coronary syndrome (ACS). Material and methods: The omega-3 index was measured in 572 consecutive patients admitted with chest pain and suspected ACS in an inland Northern Argentinean city with a dietary habit essentially based on red meat and a low intake of fish. The median age of the included patients was 63 years and 59 % were males. Clinical endpoints were collected during a 5-year follow-up period, median 3.64 years, range 1 day to 5.46 years. Stepwise Cox regression analysis was employed to compare the rate of new events in the quartiles of the omega-3 index measured at inclusion. In our multivariable analysis we corrected for age, sex, arterial hypertension, diabetes, smoking history, body mass index, previous coronary heart disease, high-sensitivity C-reactive protein, brain natriuretic peptide, Troponin-T release and use of statins and beta-blockers. Results: No statistical significant differences in baseline characteristics were noted between quartiles of the omega-3 index. The median omega 3-index was 2.8%, and ranging from 1.9% in the lowest to 3.8% in the highest quartile. During the follow-up period, 100 (17.5%) patients died. Event rates were similar in all quartiles of the omega-3 index, with no statistical significant differences. Conclusions: In a population with a low intake of fish and fish oils, the omega-3 index did not predict future fatal events in patients with acute chest pain and suspected ACS, suggesting that index levels less than 4% are too low to be protective.

Prognostic value of a normal Artificial Intelligence applicative response in subjects with stable chest pain. From the ARTICA co-operative registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Mazzanti ◽  
E Shirka ◽  
M Marini ◽  
A Pottle ◽  
A Goda ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Chest Pain ◽  
Primary Endpoint ◽  
Prognostic Value ◽  
Point Of Care ◽  
Significant Coronary Artery Disease ◽  
Coronary Syndrome ◽  
Esc Guidelines ◽  
Stable Chest Pain

Abstract Background An innovative artificial intelligence (AI) Decision Support System (DSS) ESC guidelines based has already been used at point of care with efficacy for evaluating subjects with stable chest pain (SCP) and it has been proved to correctly identify absence of significant coronary artery disease (CAD) versus standard care approach (SD) without known prognostic implication yet. Purpose The aim is to determine the prognostic value of “no testing/Follow up” AI DSS response in a referral population evaluated for SCP. Methods From 2016 to 2019, an AI DSS ESC guidelines based applicative was used on 1.291 subjects with SCP to determine testing appropriateness compared with human specialist standard evaluation. 590 of them, 332 males, mean age 62±11 years deemed to be completely negative – by “no testing/follow up” response - were evaluated. The negative response was defined and confirmed by a normal Coronary Tomography Angiography scan executed in all these subjects. Mean follow-up was 3.46±1.76 years. Two groups based on pre-test likelihood of having CAD were analyzed – low and intermediate. No subjects with high pre-test likelihood were present. The primary endpoint was cumulative incidence of cardiovascular death, hospitalizations for acute coronary syndrome and coronary revascularizations. Results The primary endpoints classification is displayed in the Table. The unadjusted hazard ratio for primary endpoint was 3.84 (95% CI 0.32–8.68, p=0.009) in patients with intermediate compared to those with low pre-test likelihood of CAD. Moreover, the “no testing and Follow up” response showed an incremental prognostic value over conventional risk factors (χ2=7, P=0.022) and over a combination of conventional factors and ST-T changes (χ2=9, P=0.014). Conclusions In an outpatient population without known CAD evaluated for chest pain, after the administration of AI DSS, a “No tests/Follow up” confers an excellent prognosis regardless of the ESC SCORE Charts and rest ECG abnormalities. These preliminary data confirms the safety of ARTICA AI DSS use in subjects with stable chest pain. Funding Acknowledgement Type of funding source: None

scholarly journals Prognosis and follow-up of young patients admitted to a critical coronary care unit with acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
DF Arroyo Monino ◽  
C Barea Gonzalez ◽  
MP Ruiz Garcia ◽  
T Seoane Garcia ◽  
JC Garcia Rubira
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Coronary Care Unit ◽  
Young Patients ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Coronary Care

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The presence of young patients admitted to a Critical Coronary Care Unit (CCCU) with the diagnosis of Acute Coronary Syndrome (ACS) is very common nowadays. The prognosis of these patients seems to be better than the elderly ones, although there are few records that endorse this statement. Objective Our aim is to carry out a follow-up of this population and study their prognosis during the index hospitalization and the follo-up. Methods Retrospective, descriptive, unicentric and observational registry of young patients (<45 years old) admitted to one CCCU with the diagnosis of ACS between January 2.010 and November 2.020. The follow-up of these patients was performed using the electronic platform of Andalusian Health Security System. Results A total number of 252 patients were included in the registry, with a mean age of 40 years old, being male 206 (81,7%). The main reason of the admission was ACS with persistent ST segment elevation (STEMI) (177 patients – 70,2%). The most prevalent risk factor in this population was active smoking (198 patients – 78,6%). The main underlying mechanism of the ACS was the rupture of an atherosclerotic plaque (194 patients – 77%) and in most cases, there was only 1 coronary artery affected (153 patients – 60,7%). Intra-hospital mortality was low (2 patients died of cardiovascular cause – 0,8%, and 1 died of non-cardiovascular cause – 0,4%). Left ventricle ejection fraction (LVEF) at the discharge was preserved in 166 patients (65,9% - mean 58%), and reduced (<40%) in 37 patients (14,7%). The median of the follow-up was 77 months (minimum 1 month and maximum 132 months). A total number of 5 patients died during this follow-up (2%, 3 during the first year), 3 of them of cardiovascular cause; these 3 patients had reduced LVEF at the discharge. During this follow-up, 64 (25,4%) patients were re-admitted to the hospital due to cardiovascular causes, most of them (30 – 11,9%) with the diagnosis of chest pain and 20 of them (7,9%) with the diagnosis of a new ACS. Conclusions Young patients admitted to our CCCU with the diagnosis of ACS presented most frequently with STEMI, affecting predominantly one coronary artery. Most of them had preserved LVEF at the discharge. The prognosis of this group of patients is good, with a low intra-hospital mortality and during the follow-up, with clear relation with the presence of reduced LVEF at the discharge. Re-admission was relatively frequent, mostly due to chest pain.

scholarly journals Recommendation for Inclusion of Surface Echocardiography in Evaluation of Chest Pain in Acute Emergency Care

2021 ◽  
Vol 5 (02) ◽  
pp. 097-102
Author(s):  
Viju Wilben ◽  
Dhruvin Limbad ◽  
Bijay BS ◽  
Srinath TS ◽  
Muralidhar Kanchi
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Angiography ◽  
Emergency Care ◽  
Predictive Value ◽  
Confusion Matrix ◽  
True Negative ◽  
Coronary Syndrome ◽  
Bedside Echocardiography ◽  
St Segment

Abstract Objective  A significant number of conditions may mimic acute myocardial infarction when patients present to acute emergency care (AEC) with chest pain. A proportion of such patients may exhibit ST segment abnormality on the electrocardiogram (ECG) which is due to conditions other than acute coronary syndromes (ACS) or myocardial infarction. The American Heart Association/American College of Cardiology guidelines (2015) algorithm for ACS does not include echocardiographic evaluation in the assessment of chest pain. Patients with chest pain may be subjected to investigations and interventions based on ECG leading unwarranted invasive procedures, which may prove unnecessary, futile, and even detrimental. This study was performed to determine if a bedside echocardiography would help identify the conditions that do not need intervention and might possibly change the treatment pathway at the right time. Materials and Methods In a prospective observational study design, adult patients presenting to AEC with chest pain were included in the study. After the assessment of airway, breathing and circulation, and initiation of bed side monitoring, a 12-lead ECG was obtained. Patients exhibiting a significant ST change on ECG were subjected to bedside echocardiography, that is, two-dimensional (2D) transthoracic echocardiography (2D-TTE) with a cross reference to a consultant cardiologist for the precise assessment and diagnosis. The findings of echocardiography were correlated with electrocardiogram for possible diagnostic coronary angiography and percutaneous coronary intervention. The results of ECG, echocardiography, and coronary angiography (if done) were analyzed to determine the sensitivity and specificity of echocardiography for ACS. Results Among 385 patients in the study, 312 were suspected to suffer acute coronary syndrome; among these patients, eight patients turned out to have chest pain due to non-ACS. Of the 73 patients, the chest pain was suspected to be not of cardiac ischemia origin; among these patients, 66 patients were true negative and 7 patients were false positive. Echocardiography was the predictive of ischemic chest pain with a predictive value of 97.7%. The specificity of echocardiography calculated from the above confusion matrix was 90.4% and sensitivity was 97.4%. The positive predictive value of 2D-TTE was 97.7% and negative predictive value was 89.1%. The overall accuracy of bedside 2D-TTE was 96.1%. Conclusion Echocardiography was found to be an effective tool in aiding diagnosis of a patient presenting to AEC with chest pain and ST-T changes in ECG. A significant percentage of patients (18.7%) presented to AEC with chest pain, ST-T changes and found to have causes other than ACS, and screening echocardiography (2D-TTE) was able to identify 90.4% of those cases. From this study, we conclude that bedside echocardiography had high specificity (90.4%) and sensitivity (97.43%) in identifying regional wall motion abnormality due to ACS. Hence, bedside echocardiography is recommended in patients with chest pain and ST-segment abnormality to avoid unnecessary delay in diagnosis and invasive interventions in non-ACS.

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