Prognosis and symptoms one year after discharge from the emergency department in patients with acute chest pain

Abstract

Background: A high proportion of patients admitted to a medical emergency department due to chest pain are directly sent home, since the initial suspicion of acute myocardial infarction (AMI) can be quickly ruled out.

Aim: To describe the outcome of such patients during 1 year of follow-up in terms of mortality, development of AMI, and especially severity of symptoms 1 year after discharge.

Methods: All patients who during 21 months were admitted to the medical emergency department at Sahlgrenska Hospital, Göteborg, Sweden, due to chest pain, and who could be directly sent home, were prospectively followed up for 1 year. Their outcome was compared with patients who had chest pain and were hospitalized for AMI during the same time.

Results: Patients with chest pain directly sent home (n = 2,102) had a median age of 52 years (age range, 16 to 96 years), and 54 percent were men. The mortality during 1 year was 3 percent, and 3 percent developed AMI. As compared with patients with AMI, those who were directly sent home less frequently reported various cardiovascular symptoms, with the exception for chest pain at rest and palpitations. On the other hand, various emotional and psychosomatic symptoms were more frequently reported by patients who were directly sent home than by patients with AMI.

Conclusion: Patients who came to a medical emergency department due to chest pain, and who were sent home, had a low risk of death and development of infarction during the following year. Survivors after 1 year do, however, more frequently report emotional and psychosomatic symptoms than survivors of AMI.