Missed Opportunities in Symptomatic Patients before a First Acute Coronary Syndrome: The EPIHeart Cohort Study
Carla Araújo1, Olga Laszczyńska, Marta Viana
1EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
Insights
Many patients experiencing acute coronary syndrome (ACS) report prior chest pain but do not receive timely diagnosis. Hypertension increases the likelihood of seeking care, while factors like social class and smoking history influence it. Opportunities exist to improve pre-event diagnosis of myocardial ischemia.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Acute coronary syndrome (ACS) is a leading cause of mortality worldwide.
- Early diagnosis and intervention are crucial for improving patient outcomes.
- Understanding patient pathways and healthcare interactions preceding ACS is vital for preventative strategies.
Purpose of the Study:
- To determine the proportion of first-time ACS patients who experienced chest pain prior to the event.
- To assess how many of these patients sought medical attention and underwent diagnostic tests like electrocardiograms (ECG).
- To identify factors influencing patients' decisions to seek medical care and undergo ECGs.
Main Methods:
- A cohort study involving 690 patients with a first episode of ACS.
- Data collected via questionnaires on preceding chest pain (within 6 months) and healthcare utilization.
- Logistic regression analysis used to identify determinants of seeking care and ECG performance.
Main Results:
- 61% of patients reported preceding chest pain; 43% sought medical help, and less than half of those had an ECG.
- Hypertension was associated with increased likelihood of seeking care.
- Former smokers and higher social class were associated with decreased likelihood of seeking care.
- ECG performance was linked to male sex, health coverage, and northeastern region residence, but inversely associated with cognitive impairment and employment.
Conclusions:
- Significant opportunities exist to enhance the diagnosis of myocardial ischemia before acute coronary events occur.
- Targeted interventions may improve pre-event medical evaluation for patients at risk of ACS.
- Further research is needed to optimize diagnostic pathways and reduce ACS incidence.
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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