Prehospital management and outcomes of patients calling with chest pain as the main complaint

Background
Chest pain is a frequent cause of health care contacts. We examined the prehospital management, in-hospital discharge diagnoses, and mortality of patients calling a non-emergency and emergency medical service with chest pain.

Methods
We included all calls to a non-emergency medical helpline (calls to 1813) and emergency medical service (1-1-2 calls) with a primary complaint of chest pain from 2014–2018 in Copenhagen, Denmark. The outcomes were: emergency response (ambulance dispatch, other transports/self-transport/home visits, self-care, and unknown/cancelled response), in-hospital diagnosis within 7 days after the call (cardiovascular, pulmonary, or other non-cardiovascular/pulmonary) and 30-day mortality.

Results
Among 4,838,232 calls, 91,671 were registered with chest pain by medical dispatchers. The first call for each patient was kept for analysis (n = 66,672). In total, 91.4% were referred to the hospital, 75.8% (n = 50,627) received an ambulance and 15.6% (n = 10,383) received other transport/self-transport/home visits. In total, 26.9% (n = 17,937) were diagnosed with a cardiovascular disease (Acute Coronary Syndrome (ACS): 11.1%), 5.2% (n = 3,490) a pulmonary disease, 52.8% (n = 35.242) other non-cardiovascular/pulmonary disease, and 15.1% (n = 10,093) received no diagnosis. Among ambulance-transported patients, the prevalence of cardiovascular discharge diagnoses was higher (32.1%) and fewer received no diagnosis (11.0%). Cardiovascular disease was rare among patients not transported by ambulance and patients who were not referred to hospital at all (2-13.4%) and in patients ≤ 40 years of age (< 10%). The 30-day mortality was low regardless of the diagnosis (0.6-4%), and 65,704 were still alive 30 days later.

Conclusion
Nearly all patients calling with chest pain were referred to treatment and among ambulance-transported patients, one-third received a cardiovascular diagnosis. While current practices appear reasonable, improved differentiation of chest pain in telephone consultations could potentially reduce burden of non-acute chest pain consultations.