Assessment, Management and Quality of Care of Patients Presenting with Non-Traumatic Acute Chest Pain in the Emergency Room who had Acute Coronary Syndrome.

BACKGROUND

Non-traumatic Acute Chest pain (NTACP) is a common presentation in the emergency services of many hospitals and a key presenting symptom of acute coronary syndrome (ACS). However, there is a dearth of data on the system of care of ACS patients in our facilities.

OBJECTIVE

Our objective was to evaluate the process of care of patients presenting with NTACP at a Tertiary Hospital emergency department (ED) in sub-Saharan Africa, using quality indicators of a universal chain of survival to identify any care gaps in the diagnosis and management of those with life-threatening ACS.

METHODS

This was a retrospective cross-sectional study of adult patients ≥18 years of age, seen between July 2020 and June 2023 at the ED of the University College Hospital (UCH), Ibadan, Nigeria. We used this information to determine the frequency of ACS amongst those presenting with NTACP. From this subset, we assessed the main domains of quality indicators of the universal chain of survival in ACS care. These were, early symptom recognition and call for help; emergency medical service (EMS) evaluation and treatment; ED evaluation and treatment; and reperfusion therapy.

RESULTS

We assessed a total of 4,306 patients who presented to the ED during the study period. Of these, 225 patients presented with NTACP. The mean ± SD age of these patients was 45.9 ± 18.4 years, with most between the ages of 40-49 years (20.9%) and males (50.7%). More than 80% of the patients presented to ED 12 hours after the onset of chest pain. Only 4.0% presented via an ambulance service which offered no prehospital guideline-directed medical treatment, and 70.7% were non-referred patients. Only 37.3%, 57.8%, 12.4%, and 8.9% had ECG, chest x-ray, echocardiography, and cardiac enzyme evaluation, respectively, in the acute phase of care. There were 29 (12.9%) patients who had a diagnosis of ACS. Two (6.9%) had medical revascularization with thrombolytic agents, while 8 (27.6%) and 19 (65.5%) were referred for primary and secondary PCI respectively.

CONCLUSION

We found a high burden of late presentation and significant barriers to recommended guideline management of ACS patients, presenting with clinical features of NTACP in our hospital's ED.