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Published on: October 24, 2020
Chest pain in lupus patients: the emergency department experience
Masoom Modi1, Mariko L Ishimori1, Vaneet K Sandhu1
1Division of Rheumatology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite B131, Los Angeles, CA, 90048, USA.
Insights
Chest pain (CP) in Systemic Lupus Erythematosus (SLE) patients presenting to the emergency department (ED) occurs in 15% of visits. Most cases are attributed to non-cardiac causes, highlighting a need for further investigation.
Area of Science:
- Rheumatology
- Cardiology
- Emergency Medicine
Background:
- Heart disease is a significant cause of illness and death in patients with Systemic Lupus Erythematosus (SLE).
- Chest pain (CP) is a common symptom presentation for SLE patients in the emergency department (ED).
Purpose of the Study:
- To determine the prevalence and outcomes of chest pain (CP) presentations in SLE patients within the emergency department (ED).
- To analyze the diagnostic work-up and discharge diagnoses for SLE patients presenting with CP.
Main Methods:
- Retrospective review of billing records for SLE patients with secondary CP codes (ICD-9: 786.50-786.59) at Cedars-Sinai Medical Center ED (March 2009-October 2013).
- Patients were categorized into two groups: discharged from ED or hospital admission.
- Evaluation included basic cardiac work-up (EKG, cardiac enzymes) and analysis of CP etiology and discharge diagnoses for admitted patients.
Main Results:
- Of 2675 SLE ED visits, 397 (15%) had CP codes; 173 were discharged, and 224 admitted.
- While 92% of admitted patients received basic cardiac work-up, over 50% of CP cases were attributed to non-cardiac causes.
- Only 7.2% of admitted SLE patients with CP received a cardiovascular disease-related discharge diagnosis.
Conclusions:
- Chest pain (CP) in SLE patients presenting to the ED is more prevalent (15%) than in the general population (10%) and often has non-cardiac etiologies.
- Despite cardiac work-up, a majority of CP diagnoses in SLE patients are non-cardiac, suggesting a need for further research into CP etiology.
- CP presentations in SLE patients represent a critical opportunity to address underlying cardiac morbidity and mortality.
Abstract:
Heart disease, a major cause of morbidity and mortality in SLE patients, often manifests as chest pain (CP). Our goal was to understand the prevalence and outcome of CP presentations for SLE patients in the emergency department (ED). Billing records of patients who presented to Cedars-Sinai Medical Center ED with ICD-9 codes for SLE and secondary ICD-9 codes for CP (786.50-786.59) between March 2009 and October 2013 were reviewed. Two study groups were formed: discharge from ED versus hospital admission. Visits were evaluated for basic cardiac work-up with an electrocardiogram (EKG) and cardiac enzymes; hospital admissions were evaluated for CP etiology and discharge diagnoses. Of 2675 ED visits with ICD-9 codes for SLE, 397 visits had secondary codes for CP (15%); 173 were discharged and 224 became hospital admissions. While 92% of admissions had basic cardiac work-up, over 50% had chest pain attributed to non-cardiac causes. Only 7.2% had a discharge diagnosis related to cardiovascular disease. Fifteen percent of all SLE coded patients had complaints of CP, a figure higher than the national average for non-SLE CP (10%). There is a majority of non-cardiac diagnoses given to SLE patients at discharge. CP is likely to be a window of opportunity to address the known cardiac morbidity and mortality in SLE patients perhaps at an early stage of development of this complication. Our study strengthens the need for more investigations to assess the etiology of CP in this population.
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