November 28, 2018BMC Cardiovascular DisordersOpen Access

Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute chest pain and presumed acute coronary syndrome (n=1603). Intervention: Higher estimated intensity of chest pain (VAS score) vs. Lower estimated intensity of chest pain. Primary outcome: Final diagnosis of acute myocardial infarction (OR 1.13, 95% CI 1.04-1.23, p=0.003).

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Key result

Higher estimated intensity of chest pain at prehospital assessment was significantly associated with an increased likelihood of a final diagnosis of acute myocardial infarction (adjusted OR 1.13 per VAS unit).

Why the study?

Early assessment of ACS is important to reduce cardiovascular morbidity and avoid complications, prompting investigation into the relationship between prehospital chest pain intensity and subsequent outcomes.

Does higher reported intensity of chest pain at first prehospital assessment predict worse subsequent outcomes in patients with suspected acute coronary syndrome?

Population

1603 patients with suspected ACS and pain intensity ≥4 on visual analogue scale

Comparison

Estimated intensity of chest pain at prehospital assessment

Design

Combined prospective and retrospective observational study

Follow-up

three years

Authors

MHMats HolmbergUppsala University HAHenrik AnderssonLinnaeus University CLCamilla LundbergSödra Älvsborg Hospital

Discussion

Member takes

Implication

May refine prehospital triage in suspected ACS; leaves open value for mortality prediction or practice change.

Study Design

Type

Observational (n=1,603)

Multicenter

Yes

Structured PICO

Does higher reported intensity of chest pain at first prehospital assessment predict worse subsequent outcomes in patients with suspected acute coronary syndrome?

Population

1,603 adults with acute chest pain and presumed acute coronary syndrome, with an initial pain intensity of ≥4 on the visual analogue scale, assessed by ambulance crews in Sweden.

Exposure

Higher reported intensity of chest pain (VAS 6.00-7.99 or ≥8.00)

Comparator

Lower reported intensity of chest pain (VAS 4.00-5.99)

Outcome

Complications before and after arrival in hospital (heart failure, hypotension, AV-block, arrhythmias), anxiety, chest pain requiring treatment, final diagnosis, duration of hospitalization, and mortality (30-day and 3-year).

Main Result

Odds Ratio: 1.13 (95% CI 1.04–1.23)

Absolute Event Rate: 33.1% vs 22.4%

p-value: p=0.003

Higher self-reported chest pain intensity in the prehospital setting is associated with a higher likelihood of acute myocardial infarction and in-hospital complications, but does not predict short- or long-term mortality.

Limitations

VAS does not collect information about pain quality, duration, or localisation.
Only included patients with an estimated initial VAS of ≥4, missing the full spectrum of chest pain experience.
Excluded patients with a systolic blood pressure of < 100 mmHg, focusing on a more stable clinical cohort.
Possible selection bias due to the requirement for informed consent.
No external monitor to validate the quality of data for clinical endpoints.
Unmeasured confounders, such as revascularization, may affect the association with mortality.
Selection bias due to informed consent requirement, potentially excluding patients with the most severe symptoms
No external monitor to validate clinical endpoints
Unmeasured confounders such as revascularization
Inclusion of patients with less time-dependent conditions like chronic angina pectoris

Cite This Study

Holmberg et al. (2018) conducted an observational in Acute chest pain and presumed acute coronary syndrome (n=1,603). Higher estimated intensity of chest pain (VAS score) vs. Lower estimated intensity of chest pain was evaluated on Final diagnosis of acute myocardial infarction (OR 1.13, 95% CI 1.04-1.23, p=0.003). Higher estimated intensity of chest pain at prehospital assessment was significantly associated with an increased likelihood of a final diagnosis of acute myocardial infarction (adjusted OR 1.13 per VAS unit).

synapsesocial.com/papers/6a9b55710b2d2a19eac3af9d https://doi.org/10.1186/s12872-018-0957-3

Topics

Heart failure HFrEF treatment

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Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider