Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Some chest pain patients may benefit from more evaluation

01.11.2004


New research shows that almost 3 percent of patients who went to hospital emergency rooms with chest pain – but who weren’t initially diagnosed with heart problems – went on to have heart attacks or other heart-related events within a month.



The study, by Wake Forest University Baptist Medical Center researchers and colleagues from seven other medical centers, will be reported in the December issue of Annals of Emergency Medicine and is currently available on-line. "Not all chest pain is heart related and, unfortunately, some patients whose pain is diagnosed as non-heart related end up having heart attacks," said Chadwick Miller, M.D., lead researcher, from Wake Forest Baptist. "We wanted to know how frequently this happens and what characteristics these patients have in common that could help physicians in the difficult task of evaluating chest pain."

The researchers reviewed data from 15,608 patients who were evaluated for chest pain in nine hospital emergency departments between June 1999 and July 2001. All patients with a diagnosis of non-cardiac chest pain were contacted by phone, and researchers reviewed their hospital records to determine their outcome at 30 days. Other diagnoses included heart attack, low-risk chest pain, unstable angina and high-risk chest pain.


The analysis found that 2.8 percent of patients who were initially diagnosed with non-cardiac chest pain had definitive evidence of a heart attack, unstable angina, cardiac death or a procedure to re-open blocked heart vessels within a month after their diagnosis. Another 3.5 percent of the patients had possible evidence of an adverse heart event, but there was not enough information to say for sure.

Miller said these levels may seem relatively low, but would represent a significant level of death and illness on a nationwide scale.

There is no single, definitive test to diagnose heart attacks, making it difficult to evaluate chest pain patients, the researchers said. It is too costly to admit seemingly low-risk patients to the hospital for extensive testing. On the other hand, physicians do not want to miss a heart attack diagnosis.

Most doctors err on the side of caution, the researchers said. More than two-thirds of patients admitted to the hospital with chest pain are not having a heart attack. Physicians typically base treatment decisions on an initial impression from the patient’s history, physical exam and findings from an electrocardiogram. "This is a practical approach, but until this study, there was no information on the outcomes of patients with a diagnosis of non-cardiac chest pain," said Miller.

Causes of non-cardiac chest pain can include stomach disorders, blood clots in the lungs, pneumonia, chest wall disorders, and anxiety.

The researchers found that patients who were diagnosed with non-cardiac chest pain and then had heart events were older (61 year versus 48 years) and more likely to be men (60 percent versus 39 percent) than the patients who did not have events. Other factors associated with adverse cardiac events were high cholesterol, diabetes, a history of heart vessel disease and a history of congestive heart failure, which is when the heart does not pump enough blood to meet the body’s demands. "When the doctor’s initial impression is non-cardiac chest pain, further evaluation should be considered if the patient has high-risk features such as a history of heart vessel disease, older age and high cholesterol," said Miller.

The researchers said the findings could help improve care and reduce costs. "If we could use this new information to reduce the number of patients who have heart attacks after leaving the emergency department, quality will improve," said Miller. "Furthermore, if physicians can safely identify a group of patients who do not require additional evaluation, health care spending will decrease."

Karen Richardson | EurekAlert!
Further information:
http://www.wfubmc.edu

More articles from Studies and Analyses:

nachricht Study relating to materials testing Detecting damages in non-magnetic steel through magnetism
23.07.2018 | Technische Universität Kaiserslautern

nachricht Innovative genetic tests for children with developmental disorders and epilepsy
11.07.2018 | Christian-Albrechts-Universität zu Kiel

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Unraveling the nature of 'whistlers' from space in the lab

A new study sheds light on how ultralow frequency radio waves and plasmas interact

Scientists at the University of California, Los Angeles present new research on a curious cosmic phenomenon known as "whistlers" -- very low frequency packets...

Im Focus: New interactive machine learning tool makes car designs more aerodynamic

Scientists develop first tool to use machine learning methods to compute flow around interactively designable 3D objects. Tool will be presented at this year’s prestigious SIGGRAPH conference.

When engineers or designers want to test the aerodynamic properties of the newly designed shape of a car, airplane, or other object, they would normally model...

Im Focus: Robots as 'pump attendants': TU Graz develops robot-controlled rapid charging system for e-vehicles

Researchers from TU Graz and their industry partners have unveiled a world first: the prototype of a robot-controlled, high-speed combined charging system (CCS) for electric vehicles that enables series charging of cars in various parking positions.

Global demand for electric vehicles is forecast to rise sharply: by 2025, the number of new vehicle registrations is expected to reach 25 million per year....

Im Focus: The “TRiC” to folding actin

Proteins must be folded correctly to fulfill their molecular functions in cells. Molecular assistants called chaperones help proteins exploit their inbuilt folding potential and reach the correct three-dimensional structure. Researchers at the Max Planck Institute of Biochemistry (MPIB) have demonstrated that actin, the most abundant protein in higher developed cells, does not have the inbuilt potential to fold and instead requires special assistance to fold into its active state. The chaperone TRiC uses a previously undescribed mechanism to perform actin folding. The study was recently published in the journal Cell.

Actin is the most abundant protein in highly developed cells and has diverse functions in processes like cell stabilization, cell division and muscle...

Im Focus: Lining up surprising behaviors of superconductor with one of the world's strongest magnets

Scientists have discovered that the electrical resistance of a copper-oxide compound depends on the magnetic field in a very unusual way -- a finding that could help direct the search for materials that can perfectly conduct electricity at room temperatur

What happens when really powerful magnets--capable of producing magnetic fields nearly two million times stronger than Earth's--are applied to materials that...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Within reach of the Universe

08.08.2018 | Event News

A journey through the history of microscopy – new exhibition opens at the MDC

27.07.2018 | Event News

2018 Work Research Conference

25.07.2018 | Event News

 
Latest News

Unraveling the nature of 'whistlers' from space in the lab

15.08.2018 | Physics and Astronomy

Diving robots find Antarctic winter seas exhale surprising amounts of carbon dioxide

15.08.2018 | Earth Sciences

Early opaque universe linked to galaxy scarcity

15.08.2018 | Physics and Astronomy

VideoLinks
Science & Research
Overview of more VideoLinks >>>