Changes in cases of nontraumatic chest pain treated in a chest pain unit over the 10-year period of 2008–2017
López-Barbeito B, Martínez-Nadal G, Bragulat E, Sánchez M, Gil V, Alonso JR, Aguiló S, García A
, Ortega M, Gómez E, Galicia M, Antolín A, Jiménez S, Salgado E, Perelló R, Coll-Vinent B, Miró O
Affiliation of the authors
Área de Urgencias. Hospital Clínic. Universitat de Barcelona. Barcelona, España.
López-Barbeito B, Martínez-Nadal G, Bragulat E, Sánchez M, Gil V, Alonso JR, et al. Changes in cases of nontraumatic chest pain treated in a chest pain unit over the 10-year period of 2008–2017. Emergencias. 2019;31:377-84
Summary
Objective.
To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period.
Methods.
All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses.
Results.
A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final
diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001).
Conclusions.
The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time.
