Incidence, diagnoses and outcomes of ambulance attendances for chest pain: a population-based cohort study

Abstract

Aims: This study aimed to determine incidences, diagnoses, and outcomes of patients with chest pain attended by paramedics using a large population-based sample.

Methods: Consecutive emergency medical services (EMS) attendances for non-traumatic chest pain in Victoria, Australia from January 2015 to June 2019 were included. Data were individually linked to emergency, hospital admission and mortality records.

Results: During the study period (representing 22,186,930 person-years), chest pain was the reason for contacting EMS in 257,017 of 2,736,570 attendances (9.4%). Overall incidence of chest pain attendances was 1,158 (per 100,000 person-years) with a higher incidence observed with increasing age, among females, among Aboriginal and Torres Strait Islanders, in regional settings, and in socially disadvantaged areas. The most common diagnoses were non-specific pain (46%; 30-day mortality 0.5%), non-ST elevation myocardial infarction (5.3%; mortality 1.3%), pneumonia (3.8%; mortality 3.9%), stable coronary syndromes (3.5%; mortality 0.8%), unstable angina (3.3%; mortality 1.3%), and ST-elevation myocardial infarction (2.8%; mortality 7.0%), while pulmonary embolism (0.7%; mortality 3.2%) and aortic pathologies (0.2%; mortality 22.2%) were rare.

Conclusions: Chest pain accounts for one in ten ambulance calls, and underlying causes are diverse. Almost half of patients are discharged from hospital with a diagnosis of non-specific pain and low rates of mortality.

Keywords: Acute coronary syndromes; Chest pain; Emergency medical services; Epidemiology; Outcomes.