Joint clinical practice guidelines have been issued by the American Heart Association (AHA) and the American College of Cardiology (ACC) for the evaluation and diagnosis of chest pain in adult patients.
Chest discomfort associated with a heart attack or heart event may often be felt beyond the chest, a joint AHA and ACC press release notes, adding that a new approach to evaluate the source and symptoms of chest pain can help clinicians improve patient outcomes and reduce healthcare costs.
The new guidelines, authored by a committee chaired by Martha Gulati (University of Arizona, Phoenix, USA) recommend that clinicians use standardised risk assessments, clinical pathways and tools to evaluate and communicate with people experiencing chest pain. The guidelines have been published in Circulation and the Journal of the American College of Cardiology (JACC).
Among all adults who come to the emergency department with chest pain, only around 5% will have acute coronary syndrome (ACS). 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.
According to AHA and ACC, evaluating the severity and the cause of chest pain is crucial. The new guidelines advise 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 hospitalisation or testing, the guideline notes. Thorough screening may also determine who is at high risk versus 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.
“When some people arrive in the emergency department with chest pain, they often won’t need additional or immediate testing, and the health care team should explain to the patient and their family the various initial tests and risk assessment and their risk level,” said Gulati. “Often, patients have additional concerns because they fear a heart attack or other severe cardiac event, which is understandable. However, we have advanced tools that help us determine whether a cardiac emergency or severe heart event is likely or not.”