Key result
SOB in chest discomfort callers linked to ~103% greater high urgency allocation but not ACS.
Why the study?
It was unknown whether shortness of breath is valuable for recognising acute coronary syndrome during telephone triage in out-of-hours primary care.
Does shortness of breath predict acute coronary syndrome or high urgency allocation in male and female callers to out-of-hours primary care with chest discomfort?
Cross-Sectional (n=2,195)
Does shortness of breath predict acute coronary syndrome or high urgency allocation in male and female callers to out-of-hours primary care with chest discomfort?
Shortness of breath in patients with chest discomfort calling out-of-hours primary care leads to higher urgency allocation, which is appropriate for women but not for men regarding the risk of ACS or other life-threatening diseases.
Answers are grounded in this paper and cite their sources.
SOB prompts higher urgency allocation in chest discomfort calls without ACS link; leaves open sex-specific triage refinements in out-of-hours care.
OBJECTIVE: Chest discomfort and shortness of breath (SOB) are key symptoms in patients with acute coronary syndrome (ACS). It is, however, unknown whether SOB is valuable for recognising ACS during telephone triage in the out-of-hours primary care (OHS-PC) setting. METHODS: A cross-sectional study performed in the Netherlands. Telephone triage conversations were analysed of callers with chest discomfort who contacted the OHS-PC between 2014 and 2017, comparing patients with SOB with those who did not report SOB. We determine the relation between SOB and (1) High urgency allocation, (2) ACS and (3) ACS or other life-threatening diseases. RESULTS: Of the 2195 callers with chest discomfort, 1096 (49.9%) reported SOB (43.7% men, 56.3% women). In total, 15.3% men (13.2% in those with SOB) and 8.4% women (9.2% in those with SOB) appeared to have ACS. SOB compared with no SOB was associated with high urgency allocation (75.9% vs 60.8%, OR: 2.03; 95% CI 1.69 to 2.44, multivariable OR (mOR): 2.03; 95% CI 1.69 to 2.44), but not with ACS (10.9% vs 12.0%; OR: 0.90; 95% CI 0.69 to 1.17, mOR: 0.91; 95% CI 0.70 to 1.19) or 'ACS or other life-threatening diseases' (15.0% vs 14.1%; OR: 1.07; 95% CI 0.85 to 1.36, mOR: 1.09; 95% CI 0.86 to 1.38). For women the relation with ACS was 9.2% vs 7.5%, OR: 1.25; 95% CI 0.83 to 1.88, and for men 13.2% vs 17.4%, OR: 0.72; 95% CI 0.51 to 1.02. For 'ACS or other life-threatening diseases', this was 13.0% vs 8.5%, OR: 1.60; 95% CI 1.10 to 2.32 for women, and 7.5% vs 20.8%, OR: 0.81; 95% CI 0.59 to 1.12 for men. CONCLUSIONS: Men and women with chest discomfort and SOB who contact the OHS-PC more often receive high urgency than those without SOB. This seems to be adequate in women, but not in men when considering the risk of ACS or other life-threatening diseases.
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Spek et al. (2023) conducted a cross-sectional in Chest discomfort (n=2,195). Shortness of breath vs. No shortness of breath was evaluated on Acute coronary syndrome (ACS) (OR 0.90, 95% CI 0.69 to 1.17). Shortness of breath in callers with chest discomfort was associated with high urgency allocation (OR 2.03; 95% CI 1.69-2.44) but not with acute coronary syndrome (OR 0.90; 95% CI 0.69-1.17).
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