Chest discomfort associated with a heart attack or heart event may often be felt beyond the chest, with many people reporting pain in their shoulders, arms, jaw, neck, back and upper abdomen.
In a new guideline from the American Heart Association and the American College of Cardiology, researchers found a new approach to evaluate the source and symptoms of chest pain can help clinicians improve patient outcomes and reduce health care costs.
Frequently, people have chest discomfort that is caused by a heart issue, and chest pain is the primary symptom reported for a heart attack or heart event.
However, there are times when chest pain episodes are not related to a heart event.
Experts urge people to seek immediate medical care for chest pain to determine if urgent care or further cardiac testing is needed.
The new guideline recommends medical professionals use standardized risk assessments, clinical pathways and tools to evaluate and communicate with people experiencing chest pain.
While evaluation of chest pain has been covered in previous guidelines, this is the first comprehensive guideline from the Association and the College focused solely on the evaluation and diagnosis of chest pain.
Among all adults who come to the emergency department with chest pain, only around 5% will have acute coronary syndrome (ACS is a term to describe when blood supply to the heart muscle is severely reduced or suddenly blocked).
More than half will ultimately be diagnosed with a non-cardiac reason for the chest-pain symptoms, including respiratory, musculoskeletal, gastrointestinal, psychological and other causes.
Evaluating the severity and the cause of chest pain is crucial.
The new guideline advises clinicians to use standard risk assessments to determine if a patient is at low, intermediate or high risk for having a cardiac event.
The guideline also highlights that women are unique when presenting with ACS symptoms.
Chest pain is the dominant and most frequent symptom for both men and women, however, women may be more likely to also exhibit accompanying symptoms such as nausea and shortness of breath.
For emergency department professionals evaluating people with chest pain, the initial goals should be to identify if there are life-threatening causes and to determine if there is a need for hospitalization or testing.
Thorough screening may also determine who is at high risk vs. intermediate or low risk for a cardiac event.
An individual at low risk for a cardiac event may be referred for additional evaluation in an outpatient setting rather than being admitted to the hospital.
The guideline authors emphasize there are opportunities to reduce unnecessary or inappropriate testing for some adults with chest pain, especially in the emergency department and for those patients screened as low risk for a cardiac event.
Clinicians can reduce patient fear and concerns and reduce extra testing through shared decision-making.
Research has shown that shared decision-making allows people at low risk of serious health issues to participate actively in their care.
The approach has also found fewer additional tests are performed as a result of shared decision-making, with no differences in outcomes among low-risk patients.
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The guideline is published in Circulation and simultaneously in the Journal of the American College of Cardiology. One author of the study is Martha Gulati, M.D., M.S., FACC, FAHA.
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