The recognition of acute coronary ischemia in the outpatient setting

Jaffery, Zehra; Hudson, Michael; Khanal, Sanjaya; Ananthasubramaniam, Karthik; Kim, Henry; Greenbaum, Adam; Kugelmass, Aaron D.; Jacobsen, Gordon; McCord, James

doi:10.1007/s11239-007-0153-2

Cited by 5 publications

(13 citation statements)

References 16 publications

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“…The benefits of early recognition and treatment of the deteriorating patient are well recognised (NPSA 2007) and transgress many specialties including management of sepsis (Rivers et al 2001), myocardial infarction (Jaffrey et al 2009) and stroke thrombolysis (Calleja et al 2009). Mortality rates can be significantly reduced for patients if they are identified before they deteriorate to cardio-respiratory arrest (NICE 2007).…”

Section: Introductionmentioning

confidence: 99%

Vital signs for vital people: an exploratory study into the role of the Healthcare Assistant in recognising, recording and responding to the acutely ill patient in the general ward setting

James¹,

Butler-Williams²,

Hunt³

et al. 2010

Journal of Nursing Management

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HCAs play a significant role in the detection and monitoring of acutely ill patients. Acknowledgement is needed of the contextual factors in the general ward setting which may influence the quality of this process. The educational needs identified by this study can assist managers to improve clinical supervision and educational input in order to improve the quality of care for acutely ill patients.

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Section: Introductionmentioning

confidence: 99%

Vital signs for vital people: an exploratory study into the role of the Healthcare Assistant in recognising, recording and responding to the acutely ill patient in the general ward setting

James¹,

Butler-Williams²,

Hunt³

et al. 2010

Journal of Nursing Management

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“…Depending on the time span before the ACS to define preceding chest pain, on the setting (outpatient vs. inpatient), and on the methodology used in other studies, the prevalence of chest pain before ACS varied [4,5,19] and was higher for patients with non-ST elevation acute myocardial infarction, in accordance with our results [20]. A proportion of 61% for chest pain in the previous 6 months is similar to previous findings from the 1970s [2].…”

Section: Discussionmentioning

confidence: 99%

“…Referral to ECG was used as a surrogate for the intention of further investigation of possible cardiac chest pain, as this exam is the cornerstone of the initial evaluation of patients whatever the type of health institution sought and is easily identified by patients. The low rates of performance of an ECG or other testing modalities, including exercise stress test (which was also low for the subgroup of patients who reported that pain was cardiac in origin), and the absence of performance of myocardial perfusion scintigraphy and coronary angiography, favor that inaccurate noninvasive coronary ischemia testing may be one of the factors contributing to the misdiagnosis of symptoms of myocardial ischemia [4]. Furthermore, the type of noninvasive test performed for diagnosing CHD suggests that the choice of the exam largely depended on physician preference and/or local availability [29].…”

Section: Discussionmentioning

confidence: 99%

“…Atypical presentations among women [31], the perception of a lower risk of CHD compared with men [32], and gender bias in the use of investigations for patients with stable angina have been observed [33]. Cognitive impairment was independently associated with a lower referral for ECG; poor communication is a factor contributing to the misdiagnosis of symptoms of myocardial ischemia [4]. …”

Section: Discussionmentioning

confidence: 99%

“…Potential missed opportunities of diagnosis and the management of coronary heart disease (CHD) have been described in primary care and in emergency department settings, based on medical record review, and have proved to be dependent on patient and health care system determinants [4,5]. Furthermore, only about 25% of those with chest pain, either cardiac or noncardiac, actually seek medical advice from a family physician or by presenting to a hospital emergency department [6].…”

Section: Introductionmentioning

confidence: 99%

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Missed Opportunities in Symptomatic Patients before a First Acute Coronary Syndrome: The EPIHeart Cohort Study

Araújo

Laszczyńska²,

Viana³

et al. 2017

Cardiology

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Objectives: The aim of this study was to assess the proportion of patients with a first episode of acute coronary syndrome (ACS) reporting preceding chest pain, having previously sought medical care and undergone the performance of exams, and to identify the determinants of seeking medical advice and undergoing electrocardiogram (ECG). Methods: Within a cohort study, 690 patients with a first episode of ACS were evaluated. A questionnaire was applied to assess chest pain within the preceding 6 months of the event and health system resources utilization. Determinants were identified by logistic regression. Results: Preceding chest pain was reported by 61% of patients, 43% of these sought medical help, of whom less than half underwent ECG, and in 39% pain was attributed to a problem of the heart. Patients with hypertension were more likely to seek medical care (adjusted odds ratio, OR, 2.13, 95% CI 1.29-3.51), and former smokers (OR 0.52, 95% CI 0.28-0.99) and patients of a higher social class (OR 0.16, 95% CI 0.05-0.48) were less likely to seek medical care. The performance of ECG was associated with male sex (OR 2.56, 95% CI 1.11-5.87), health subsystem coverage (OR 3.88, 95% CI 1.11-13.53), and living in the northeastern region (OR 9.07, 95% CI 4.07-20.24), whereas cognitive impairment (OR 0.37, 95% CI 0.15-0.92) and being employed (OR 0.36, 95% CI 0.14-0.97) were inversely associated. Conclusions: These results suggest there are opportunities to improve the diagnosis of myocardial ischemia before acute coronary events.

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Misdiagnosis of Acute Myocardial Infarction: A Systematic Review of the Literature

Kwok

Bennett

Azam

et al. 2021

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Despite the availability of tests to diagnose acute myocardial infarction (AMI), cases are still missed. We systematic reviewed the literature to determine how missed AMI has been defined, the reported rates of misdiagnosed AMI, the outcomes patients with misdiagnosed AMI have, what diagnosis was initially suspected in missed AMI cases, and what factors are associated with misdiagnosed AMI. We searched MEDLINE and EMBASE in September 2020 for studies that evaluated missed AMI. Data was extracted from studies that met the inclusion criteria and the results were narratively synthesized. A total of 15 studies were included in this review. The number of patients with missed AMI in individual studies ranged from 64 to 4,707.There was no consistently used definition for misdiagnosed AMI but most studies reported rates of approximately 1-2%. Compared to AMI that was recognized, one study found no difference in mortality for misdiagnosed AMI at 30 days and 1 year. The common initial misdiagnoses that subsequently had AMI were ischemic heart disease, non-specific chest pain, gastrointestinal disease, musculoskeletal pain and arrhythmias. Reasons for missed AMI include incorrect electrocardiogram interpretation and failure to order appropriate diagnostic tests. Hospitals in rural areas and those with a low proportion of classical chest pain patients that turned out to have AMI were at greater risk of missed AMI. Misdiagnosed AMI is an unfortunate part of everyday clinical practice and better training in electrocardiogram interpretation and education about atypical presentations of AMI may reduce the number of misdiagnosed AMI.

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The recognition of acute coronary ischemia in the outpatient setting

Abstract: A majority of patients with subsequent AMI visit an outpatient provider in the month preceding AMI. However, few present with symptoms of coronary ischemia in the outpatient setting (10%) and these symptoms are not always identified as such.

Cited by 5 publications

References 16 publications

Vital signs for vital people: an exploratory study into the role of the Healthcare Assistant in recognising, recording and responding to the acutely ill patient in the general ward setting

Vital signs for vital people: an exploratory study into the role of the Healthcare Assistant in recognising, recording and responding to the acutely ill patient in the general ward setting

Missed Opportunities in Symptomatic Patients before a First Acute Coronary Syndrome: The EPIHeart Cohort Study

Misdiagnosis of Acute Myocardial Infarction: A Systematic Review of the Literature

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