ACC, AHA release long-awaited chest pain guidelines
The American Heart Association (AHA) and American College of Cardiology (ACC) have unveiled new guidelines designed to help clinicians evaluate the source and symptoms of chest pain while improving patient outcomes and reducing healthcare costs.
The guidelines, published in Circulation and the Journal of the American College of Cardiology, have been in development for several years now. This represents the first time the AHA and ACC have collaborated on a comprehensive document focused on the evaluation and diagnosis of chest pain.
In a press release, the two associations explained that chest pain is frequently associated with an MI or other heart event, but the same can be true for pain felt in the shoulders, arms, jaw, neck, back or upper abdomen. Also, while women and men exhibit chest pain during a heart event, women are more inclined to experience other side effects such as nausea and shortness of breath.
The groups recommend that medical professionals use “standardized risk assessments, clinical pathways and tools” to treat and communicate with any patients who present with chest pain.
“Everyone should know the symptoms that can indicate a heart attack and that calling 911 is the most important thing to do to save their life or that of their loved one experiencing chest pain,” Martha Gulati, MD, MS, chair of the guideline writing group and a cardiologist with the the University of Arizona in Phoenix, said in a press release. “This standard approach provides clinicians with the guidance to better evaluate patients with chest pain, identify patients who may be having a cardiac emergency and then select the right test or treatment for the right patient.”
For example, among all adults who arrive at an emergency department with chest pain, approximately 5% will have acute coronary syndrome (ACS) and more than half will be diagnosed with a non-cardiac problem. These statistics highlight the importance of a proper chest pain evaluation.
“When some people arrive in the emergency department with chest pain, they often won’t need additional or immediate testing, and the health care team should explain to the patient and their family the various initial tests and risk assessment and their risk level,” Gulati added. “Often, patients have additional concerns because they fear a heart attack or other severe cardiac event, which is understandable. However, we have advanced tools that help us determine whether a cardiac emergency or severe heart event is likely or not.”
The new guidelines also suggest that clinicians can reduce patient fear and concerns and reduce extra testing through shared decision-making.
“While there is no one ‘best test’ for every patient, the guideline emphasizes the tests that may be most appropriate, depending on the individual situation, and which ones won’t provide additional information; therefore, these tests should not be done just for the sake of doing them,” Gulati said. “Appropriate testing is also dependent upon the technology and screening devices that are available at the hospital or health care center where the patient is receiving care. All imaging modalities highlighted in the guideline have an important role in the assessment of chest pain to help determine the underlying cause, with the goal of preventing a serious cardiac event.”