Outcomes in Emergency Department Patients with Dyspnea Versus Chest Pain: A Retrospective Consecutive Cohort Study

Overview

Journal Emerg Med Int

Publisher Wiley

Specialty Emergency Medicine

Date 2022 Sep 26

PMID 36158766

Authors

Erik Jemt

Magnus Ekstrom

Ulf Ekelund

Affiliations

Soon will be listed here.

Abstract

Dyspnea and chest pain are major and important causes of contact at the emergency department (ED). Dyspnea is associated with high morbidity and mortality, but data on characteristics and outcomes compared with chest pain in the ED are limited. This was a retrospective cohort study of consecutive patients with contact causes of dyspnea or chest pain at two Swedish EDs from 2010 to 2014. Hospital admittance, ED revisits, and mortality were analyzed using multivariable regression models, adjusted for ED and markers of disease severity (age, sex, centre, Charlson comorbidity index, c-reactive protein, troponin and arrival by ambulance). 29,291 patients (mean age 58.3 years; 48.9% women) with dyspnea ( = 8,812) or chest pain ( = 20,479) were included. Dyspnea patients were older than patients with chest pain (64 vs. 56 years, < 0.001) and had more comorbidity and higher average blood troponin and c-reactive protein levels. Dyspnea patients also had higher hospitalization rates (48% vs. 30%; adjOR (95% CI) 2.1-2.3), including the intensive care unit (1.4% vs. 0.1%; adjOR 6.9-15.9), and more ED revisits (11% vs. 7%; adjOR 1.2-1.7) in 30 days. Dyspnea patients had five-fold increased mortality compared to those with chest pain; hazard ratio (HR) 5.1 (4.8-5.4), adjusted for markers of disease severity, the mortality was two-fold higher, HR 2.2 (2.0-2.4). Compared with chest pain patients, ED dyspnea patients are older, have more comorbidity, and have worse outcomes in terms of hospitalization, morbidity, and mortality.

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References

Ray P, Birolleau S, Lefort Y, Becquemin M, Beigelman C, Isnard R . Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care. 2006; 10(3):R82. PMC: 1550946. DOI: 10.1186/cc4926. View

Morrone D, Morrone V . Acute Pulmonary Embolism: Focus on the Clinical Picture. Korean Circ J. 2018; 48(5):365-381. PMC: 5940642. DOI: 10.4070/kcj.2017.0314. View

Laribi S, Keijzers G, van Meer O, Klim S, Motiejunaite J, Kuan W . Epidemiology of patients presenting with dyspnea to emergency departments in Europe and the Asia-Pacific region. Eur J Emerg Med. 2018; 26(5):345-349. DOI: 10.1097/MEJ.0000000000000571. View

Karamercan M, Dundar Z, Ergin M, van Meer O, Body R, Harjola V . Seasonal variations of patients presenting dyspnea to emergency departments in Europe: Results from the EURODEM Study. Turk J Med Sci. 2020; 50(8):1879-1886. PMC: 7775711. DOI: 10.3906/sag-2002-221. View

Abidov A, Rozanski A, Hachamovitch R, Hayes S, Aboul-Enein F, Cohen I . Prognostic significance of dyspnea in patients referred for cardiac stress testing. N Engl J Med. 2005; 353(18):1889-98. DOI: 10.1056/NEJMoa042741. View

Lindow T, Wiiala J, Lundager Forberg J, Lassen A, Brabrand M, Platonov P . Optimal measuring point for ST deviation in chest pain patients with possible acute coronary syndrome. J Electrocardiol. 2020; 58:165-170. DOI: 10.1016/j.jelectrocard.2019.12.012. View

Pedersen C, Stengaard C, Friesgaard K, Dodt K, Sondergaard H, Terkelsen C . Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2019; 27(1):84. PMC: 6716930. DOI: 10.1186/s13049-019-0659-6. View

Mahler S, Riley R, Hiestand B, Russell G, Hoekstra J, Lefebvre C . The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015; 8(2):195-203. PMC: 4413911. DOI: 10.1161/CIRCOUTCOMES.114.001384. View

Fujino M, Ishihara M, Ogawa H, Nakao K, Yasuda S, Noguchi T . Impact of symptom presentation on in-hospital outcomes in patients with acute myocardial infarction. J Cardiol. 2016; 70(1):29-34. DOI: 10.1016/j.jjcc.2016.10.002. View

10.

Pesola G, Ahsan H . Dyspnea as an independent predictor of mortality. Clin Respir J. 2014; 10(2):142-52. PMC: 4309743. DOI: 10.1111/crj.12191. View

11.

Mockel M, Searle J, Muller R, Slagman A, Storchmann H, Oestereich P . Chief complaints in medical emergencies: do they relate to underlying disease and outcome? The Charité Emergency Medicine Study (CHARITEM). Eur J Emerg Med. 2012; 20(2):103-8. DOI: 10.1097/MEJ.0b013e328351e609. View

12.

Quan H, Li B, Couris C, Fushimi K, Graham P, Hider P . Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011; 173(6):676-82. DOI: 10.1093/aje/kwq433. View

13.

Safwenberg U, Terent A, Lind L . The Emergency Department presenting complaint as predictor of in-hospital fatality. Eur J Emerg Med. 2007; 14(6):324-31. DOI: 10.1097/MEJ.0b013e32827b14dd. View

14.

Brieger D, Eagle K, Goodman S, Steg P, Budaj A, White K . Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events. Chest. 2004; 126(2):461-9. DOI: 10.1378/chest.126.2.461. View

15.

Pong J, Ho A, Tan T, Zheng H, Pek P, Sia C . ST-segment elevation myocardial infarction with non-chest pain presentation at the Emergency Department: Insights from the Singapore Myocardial Infarction Registry. Intern Emerg Med. 2019; 14(6):989-997. DOI: 10.1007/s11739-019-02122-3. View

16.

Langlo N, Orvik A, Dale J, Uleberg O, Bjornsen L . The acute sick and injured patients: an overview of the emergency department patient population at a Norwegian University Hospital Emergency Department. Eur J Emerg Med. 2013; 21(3):175-80. DOI: 10.1097/MEJ.0b013e3283629c18. View

17.

Rubin L . Cor Pulmonale Revisited. From Ferrer and Harvey to the Present. Ann Am Thorac Soc. 2018; 15(Suppl 1):S42-S44. DOI: 10.1513/AnnalsATS.201710-772KV. View

18.

Kelly A, Keijzers G, Klim S, Graham C, Craig S, Kuan W . An Observational Study of Dyspnea in Emergency Departments: The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM). Acad Emerg Med. 2016; 24(3):328-336. DOI: 10.1111/acem.13118. View

19.

Kuster T, Nickel C, Jenny M, Blaschke L, Bingisser R . Combinations of Symptoms in Emergency Presentations: Prevalence and Outcome. J Clin Med. 2019; 8(3). PMC: 6462968. DOI: 10.3390/jcm8030345. View

20.

Hansen T, Pottegard A, Brandes A, Ekelund U, Jensen H, Forberg J . New-Onset Atrial Fibrillation Among Patients With Infection in the Emergency Department: A Multicenter Cohort Study of 1-Year Stroke Risk. Am J Med. 2019; 133(3):352-359.e3. DOI: 10.1016/j.amjmed.2019.06.048. View