Characteristics of chest pain and its acute management in a low-middle income country: analysis of emergency department surveillance data from Pakistan

Abstract

BackgroundChest pain is one of the most frequent causes of emergency department (ED) visits in high-income countries. Little is known about chest pain patients presenting to EDs of low- and middle-income countries (LMICs). The objective of this study was to describe the characteristics of chest pain patients presenting to emergency departments (EDs) of Pakistan and to determine the utilization of ED resources in the management of chest pain patients and their outcomes.MethodsThis study used pilot active surveillance data from seven major EDs in Pakistan. Data were collected on all patients presenting to the EDs of the participating sites to seek emergency care for chest pain.ResultsA total of 20,435 patients were admitted to the EDs with chest pain. The majority were males (M 60%, F 40%) and the mean age was 42 years (SD+/- 14). The great majority (97%, n = 19,164) of patients were admitted to the EDs of public hospitals compared to private hospitals and only 3% arrived by ambulance. Electrocardiograms (ECGs) were used in more than half of all chest pain patients (55%, n = 10,890) while cardiac enzymes were performed in less than 5% of cases. Chest X-rays were the most frequently performed radiological procedure (21%, n = 4,135); more than half of the admitted chest pain patients were discharged from the EDs and less than 1% died in the ED.ConclusionChest pain is a common presenting complaint in EDs in Pakistan. The majority received an ECG and the use of diagnostic testing, such as cardiac enzymes, is quite uncommon.

Burden of Non-cardiac Patients on the Emergency Room of a Rural Cardiac Center in Sindh, Pakistan

“…However, various causes have been identified over the years for non-cardiac symptoms, especially non-cardiac chest pain. The most common causes are GERD, esophageal hypersensitivity and dysmotility, musculoskeletal pain, MDD, and pericarditis [ 8 , 13 , 21 ].…”

“…In such a resource-limited health care system, the degree of burden of non-cardiac patients on a cardiac emergency department is worrisome. Chest pain is the leading precipitant of cardiac emergency department visits all over the world [ 8 - 11 ]. Chest pain categorized as non-cardiac in origin accounts for around 45% to 77% of the patients presenting to emergency departments [ 10 , 12 - 18 ].…”

“…The most commonly found underlying mechanisms of non-cardiac chest pain reported in past studies are gastroesophageal reflux disorder (GERD), esophageal hypersensitivity and dysmotility, musculoskeletal pain, major depressive disorder (MDD), and pericarditis [ 8 , 13 , 21 ].…”

Implementing myocardial infarction systems of care in low/middle-income countries

“…Emergency departments (ED) are quite often the first medical contact for patients with STEMI in LMIC: in Pakistan, for instance, only 3% of patients with chest pain admitted to seven major EDs arrived by ambulance,17 a common problem also in sub-Saharan Africa and India 15. The lack of an organised ED may be a cause of delay,8 with time loss in obtaining ECG at admission, activation of catheterisation laboratory and at long administrative formalities 11.…”

“…The lack of an organised ED may be a cause of delay,8 with time loss in obtaining ECG at admission, activation of catheterisation laboratory and at long administrative formalities 11. In some countries, for example, not all patients with chest pain had a diagnostic ECG in the ED, and cardiac biomarkers were rarely used 17. In LMICs, training is particularly important, because often EDs are staffed by physicians without specific training in emergency care 18.…”