Fast-Track Management of Acute Chest Pain: Experience Gained in a Hospital from Alentejo
DOI:
https://doi.org/10.24950/O/235/20/3/2021Keywords:
Cardiovascular Diseases, Chest Pain, Critical Pathways, Emergency Service, Hospital, Myocardial InfarctionAbstract
Introduction: As an effort to reduce mortality associated with acute myocardial infraction (AMI), a fast-track approach named Via Verde Coronária (VVC) was implemented nationwide in 2007. Data on how this approach is performing in different hospitals is still scarce. Our aims were to characterize the main diagnoses of patients included in VVC and to evaluate the proportion of cases diagnosed with AMI.
Material and Methods: A retrospective observational study was undertaken in the emergency department of a hospital from Alentejo (06/2017-05/2018). Patients were included if they were aged 18 or older and presented AMI-related symptoms. The main diagnosis was retrieved from medical records and the proportion of AMI was calculated. Data analysis was performed using uni- and bivariate statistics (IBM SPSS v.27.0).
Results: A total of 338 patients were included, where 56.5% (n = 191) were male with a mean age of 63.9 ± 15.1 {19;96} years old. The majority of diagnoses were from the circulatory system (61.2%, n = 207). AMI was present in 27.2% (n = 92/338) of the sample. There were differences when comparing the number of risk factors between patients with AMI and non-AMI (2.83 ± 1.54 vs 2.06 ± 1.49 risk factors/patient, respectively; p < 0.001) and in patients with NSTEMI and STEMI (3.25 ± 1.36 vs 1.81 ± 1.50 risk factors/patient, respectively; p < 0.001). There was a statistically significant difference when analyzing the duration of pain between patients with AMI and non-AMI (6.24 ± 9.08 vs 10.53 ± 18.23 hours of pain, respectively; p = 0.032).
Conclusion: Data suggest that the majority of diagnosis in VVC was related to the circulatory system, and a quarter of them were AMI.
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References
World Health Organization. Cardiovascular diseases (CVDs) [Internet]. Last update: 2017-05-17. [cited 2020 May 16]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
Shi A, Tao Z, Wei P, Zhao J. Epidemiological aspects of heart diseases (Review). Exp Ther Med. 2016;12:1645–50.
OECD. Main causes of mortality. In: Health at a Glance 2019: OECD Indicators [Internet]. Paris: OECD Publishing; 2019 [cited 2020 Sep 5]. Available from: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2019_26f50dbe-en
OECD/European Union. Mortality following acute myocardial infarction (AMI). In: Health at a Glance: Europe 2018: State of Health in the EU Cycle [Internet]. Paris/European Union, Brussels: OECD Publishing; 2018 [cited 2020 May 16]. p. 152–3. Available from: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe-2018/mortality-following-acute-myocardial-infarction-ami_health_glance_eur-2018-38-en
Instituto Nacional de Estatística. A mortalidade por tumores malignos da traqueia, brônquios e pulmão regista valores significativos a partir dos 45 anos. Causas morte - 2017. Lisboa: INE; 2017.
Pordata – Base de Dados Portugal Contemporâneo. Óbitos de residentes em Portugal por algumas causas de morte [Internet]. Last update: 2020-01-31. [cited 2020 Apr 11]. Available from: https://www.pordata.pt/Portugal/Óbitos+de+residentes+em+Portugal+por+algumas+causas+de+morte-156
Pordata – Base de Dados Portugal Contemporâneo. Óbitos por algumas causas de morte (%) [Internet]. Last update: 2020-02-10. [cited 2020 Apr 11]. Available from: https://www.pordata.pt/Portugal/Óbitos+por+algumas+causas+de+morte+percentagem)-758
Stepinska J, Lettino M, Ahrens I, Bueno H, Garcia-Castrillo L, Khoury A, et al. Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association. Eur Hear J Acute Cardiovasc Care. 2020;9:76–89.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39:119–77.
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267–315.
Konstantinides S V., Meyer G, Bueno H, Galié N, Gibbs JSR, Ageno W, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Eur Heart J. 2020;41:543–603.
Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2014;35:2873–926.
Erhardt L, Herlitz J, Bossaert L, Halinen M, Keltai M, Koster R, et al. Task force on the management of chest pain. Eur Heart J. 2002;23:1153–76.
Ferreira RC. Via verde para a vida. Teste Saúde. 2013;102:18–21.
Marques N, Faria R, Sousa P, Mimoso J, Brandão V, Gomes V, et al. Impacto da via verde coronária e da angioplastia primária na redução da mortalidade associada ao enfarte com elevac¸ão do segmento ST anterior. A experiência algarvia. Rev Port Cardiol [Internet]. 2012;31:647–54.
Direção-Geral da Saúde. Norma 002/2018 Sistemas de Triagem de Serviços urgência. Norma no 002/2018 09/01/2018 [Internet]. 2018;1–23. Available from: http://www.dgs.pt
Curfman G. Acute chest pain in the emergency department. JAMA Intern Med. 2018;178:220.
Leite L, Baptista R, Leitão J, Cochicho J, Breda F, Elvas L, et al. Chest pain in the emergency department: Risk stratification with Manchester triage system and HEART score. BMC Cardiovasc Disord. 2015;15:1–7. doi:10.1186/s12872-015-0049-6
Martínez-Sellés M, Bueno H, Sacristán A, Estévez Á, Ortiz J, Gallego L, et al. Chest Pain in the Emergency Department: Incidence, Clinical Characteristics, and Risk Stratification. Rev Española Cardiol. 2008;61:953–9.
Herren KR, Mackway-Jones K. Emergency manangement of cardiac chest pain: A review. Emerg Med J. 2001;18:6–10.
Prevention C for DC and. International Classification of Diseases,Ninth Revision, Clinical Modification (ICD-9-CM) [Internet]. Last reviewed: 2015-11-06. Available from: https://www.cdc.gov/nchs/icd/icd9cm.htm
de Mello BHG, Oliveira GBF, Ramos RF, Lopes BBC, Barros CBS, de Oliveira Carvalho E, et al. Validation of the killip–kimball classification and late mortality after acute myocardial infarction. Arq Bras Cardiol. 2014;:107–17.
Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A Two year experience with 250 patients. Am J Cardiol. 1967;20:457–64.
Ekelund U, Akbarzadeh M, Khoshnood A, Björk J, Ohlsson M. Likelihood of acute coronary syndrome in emergency department chest pain patients varies with time of presentation. BMC Res Notes. 2012;5:420. doi: 10.1186/1756-0500-5-420.
Mockel M, Searle J, Muller R, Slagman A, Storchmann H, Oestereich P, et al. Chief complaints in medical emergencies: Do they relate to underlying disease and outcome? the Charité Emergency Medicine Study (CHARITEM). Eur J Emerg Med. 2013;20:103–8.
Bjørnsen LP, Naess-Pleym LE, Dale J, Grenne B, Wiseth R. Description of chest pain patients in a Norwegian emergency department. Scand Cardiovasc J. 2019;53:28–34. doi:10.1080/14017431.2019.1583362
Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: Epidemiological update 2016. Eur Heart J. 2016;37:3232–45.
Poldervaart JM, Reitsma JB, Backus BE, Koffijberg H, Veldkamp RF, Ten Haaf ME, et al. Effect of using the HEART score in patients with chest pain in the emergency department: A Stepped-wedge, cluster randomized trial. Ann Intern Med. 2017;166:689–97.
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