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Severe Pain Not Related To Likelihood Of Heart Attack

Patients coming to the emergency department with severe pain are not any more likely to suffer heart attack or death than those with mild or moderate pain, a new study shows.

The study contradicts the widely held assumption that high pain scores indicate a high risk of acute coronary syndrome.

“It is common for lay people to cite high pain scores as a reason for patients to remain in the hospital for further testing, but our study demonstrates that is not necessarily evidence-based,” said lead study author Dr. Anna Marie Chang, of the University of Pennsylvania in Philadelphia, Penn., in a news release. “Our study provides further evidence that there is no typical presentation for acute coronary syndrome.”

Researchers examined the records of 3,306 patients who went to the emergency department with symptoms of acute coronary syndrome. Three percent of the patients with a mild or moderate pain score and 3.9 percent of patients with severe pain score had a cardiovascular event during hospitalization.

Looking at 30-day outcomes, researchers found 5.8 percent of patients with mild or moderate pain score and 7.3 percent of patients with severe pain score had an outcome of either death, revascularization or acute myocardial infarction (AMI or heart attack). However, when adjusted for sex, race, risk score and mode of arrival, pain score was not an independent predictor of 30-day cardiovascular events.

Chest pain and related symptoms cause six million visits to the emergency department and approximately two million hospital admissions every year. In the end, only a minority of these patients are diagnosed with heart problems. And two to five percent of patients with AMI are inappropriately discharged from the emergency department. 



“The issue of chest pain severity in the emergency department is complex,” said Dr. Chang. “As many as one-third of heart attacks may go unrecognized by patients, so people with chest pain should still get to the emergency department as quickly as possible to be evaluated. But patients with severe chest pain are not necessarily at increased risk for acute coronary syndrome, and though pain management is very important, pain severity itself should not be a factor in evaluating a patient’s risk for heart attack.” 



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