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Heart patients who arrive at the hospital without chest pain have triple the death rate of other cardiac patients and are less likely to receive medications to slow the progression of a heart attack, according to a study reported in the August issue of Chest.
Most heart patients experience chest pain, but some do not. Instead they may experience symptoms such as fainting, shortness of breath, excessive sweating, nausea and vomiting, according to study author David Brieger, PhD, of Concord Hospital in Sydney, Australia.
Brieger and his colleagues analyzed data from 20,881 patients in 14 countries who were hospitalized with a variety of heart conditions from July 1999 to June 2002. Of the 1,763 cardiac patients who did not experience chest pain, 13 percent died in the hospital compared to 4 percent of those with chest pain.
In addition, 24 percent of patients without chest pain were initially misdiagnosed when they arrived at the hospital, compared to only 2 percent of heart patients who experienced chest pain. Such patients were also often not given proper medication such as aspirin and beta-blockers or offered appropriate cardiac medical procedures.
Patients without chest pain tended to be older women and to have a history of diabetes, heart failure or hypertension, as opposed to patients with chest pain who were more likely to be smokers with plaque buildup in their coronary arteries, according to the researchers.
“Often, when a patient arrives at the hospital without chest pain, it is only after blood test results come back or other diagnoses are excluded that the physician reassesses the situation and determines it is an acute cardiac event after all,” said Brieger. “We hope that our findings will remind physicians that these events do occur in the absence of chest pain and will prompt them to make the diagnoses and institute the appropriate treatment more rapidly.”
Source: Medical Week Staff week of August 9, 2004
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