Characterizing Pain Leading to Emergency Medical Services Activation in Heart Failure.
Asa B Smith, Miyeon Jung, Christopher Lee and 1 others
PMID 34954742WHAT IT FOUND
More than 1 in 5 patients with heart failure transported by EMS had pain as the primary complaint, most often chest pain and often severe.
Prior heart attack was linked to pain complaints.
Key findings
01Of 4,663 patients with heart failure transported by EMS, 1,034 (22.2%) had a primary complaint of pain.
02Chest pain was the most common primary pain complaint, at 68.1% (n = 704), followed by abdominal pain (17.7%, n = 183), generalized pain (9.2%, n = 95), and back pain (5%, n = 52).
03A history of myocardial infarction was associated with 96% higher odds of presenting to EMS with a primary complaint of pain.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample came from EMS transports in one metropolitan area, so it may not represent rural heart failure populations or other health systems. Heart failure diagnosis was self-reported in EMS records and was not confirmed by echocardiography or hospital admission or discharge diagnoses. Pain severity was documented for only 312 of 1,034 patients with a pain complaint, so severity findings apply to that subset. The study was cross-sectional and observational, so it cannot show that pain caused EMS activation or that risk factors caused pain. Important contributors to pain, such as depression, anxiety, diabetes, chronic obstructive pulmonary disease, and musculoskeletal conditions, were not captured in the dataset. Age findings were reported inconsistently in the paper: pain-complaint patients were younger, the conclusion links younger age to pain, but the regression result describes lower odds for each one-year decrease in age. Pain was recorded by EMS personnel as a primary complaint, and other symptoms or comorbidities may have affected what was documented.
Declared interests
No conflicts-of-interest declaration is provided in the supplied text; the publication types list NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not use these findings to predict EMS activation from pain or assume pain management will prevent EMS. This was a cross-sectional EMS-record analysis, and pain severity was documented for only 312 of the 1,034 patients with a pain complaint.