Time for a New Whole-Person Care Pathway for Chest Pain Admissions.

Abstract

Background: Emergency department (ED) visits for chest pain are common and costly, and ED workup often shows no clear cardiac etiology in low-risk patients. Emerging evidence suggests that social determinants of health (SDOH) such as loneliness, social isolation, and food insecurity contribute to cardiovascular outcomes and chest pain presentations.

Methods: We interviewed 114 patients (>18 years) presenting with chest pain and a thrombolysis in myocardial infarction (TIMI) score less than 4 at our community teaching hospital ED. Structured questionnaires assessed the SDOH triad of loneliness, social isolation, and food insecurity. Dependent variables included systolic blood pressure (SBP) at admission, body mass index (BMI), ejection fraction (EF) within 6 months of admission, and 30-day readmissions. Correlation analyses examined significant associations between SDOH and cardiometabolic outcomes.

Results: Loneliness was prevalent in 71% of our surveyed participants (mean age of 64, 53% male, 47% female). Loneliness had a strong positive correlation with poorly controlled admission SBP and a negative correlation with EF. Higher social isolation scores had a negative correlation with EF. Food insecurity was prevalent in 71% of participants, and it had a moderate but positive correlation with higher BMI. Thirty-day readmission of patients with a prior ED hospitalization for cardiac examination was 7% across all the etiologies included in this study.

Conclusions: Because SDOH are potently present in patients who visit EDs with chest pain, locally designed screening cards should be part of the workup. The rise of the loneliness, social isolation, and food insecurity syndemics should raise our awareness to manage those risk factors individually, institutionally, and systemically.