Patient-Reported Symptoms of Acute Coronary Syndrome in the Prehospital Period in a Prospective Study: Implications for Emergency Nurse Triage, Diagnosis, and Clinical Outcomes.

Abstract

Introduction: Improving the prompt recognition of acute coronary syndrome symptoms in the prehospital period may reduce total ischemic time and improve patient outcomes. This study aimed to evaluate the occurrence, severity, and changes in patient-reported symptoms between the prehospital period and the emergency department and determine whether symptoms predicted an acute coronary syndrome diagnosis and/or adverse patient outcomes (eg, death).

Methods: Individuals who were ≥21 years old and transported by emergency medical services with nontraumatic chest pain or anginal equivalent symptoms were eligible. Patients completed the Acute Coronary Syndrome Symptom Checklist in the ambulance and on arrival to the emergency department. Chi-square, t tests, and logistic regression were used, adjusting for age, sex, and race, to estimate associations between symptoms and acute coronary syndrome diagnoses and adverse events within 30 days.

Results: The sample included 206 individuals. Chest pain was the chief complaint at T1 and T2. Participants reporting chest pressure, shoulder pain, palpitations, lightheadedness, and chest pain were significantly younger than participants without these symptoms. Sweating at T1 was associated with increased odds of an acute coronary syndrome diagnosis (odds ratio, 3.24, P = .01). At T2, chest discomfort and unusual fatigue were predictive of acute coronary syndrome diagnosis (odds ratio, 2.59 and 2.98; P < .045 and P < .03, respectively). Patients experiencing shortness of breath at either T1 or T2 had significantly increased odds of adverse events (odds ratio, 3.96 and 3.26, respectively; P = .02 and P = .04). Six symptoms decreased by ED arrival.

Discussion: Chest symptoms, sweating, fatigue, and shortness of breath should trigger concern for acute coronary syndrome in clinicians. Results indicate the importance of calling emergency medical service, which was associated with a prehospital reduction in symptoms.