Cardiovascular Resources: Evaluation of Chest Pain

Mar 28, 2022

Cardiovascular diseases (CVDs) are the leading cause of death worldwide and include disorders of the heart and blood vessels such as coronary heart disease, cerebrovascular disease, rheumatic heart disease and other conditions.^[1]Caring for patients with CVDs can be complex due to the many variables that influence heart diseases as well as the number of diagnostic and care path options available to detect and treat them. Clinicians need access to the tools that will best identify those at risk, help inform care in urgent cases and provide guidance for important follow-up care.

Second only to injuries, chest pain is the primary reason for emergency department visits for adults in the US.^[2] Although every patient’s chest pain may not be related to cardiovascular disease, it is imperative that the cause of the pain is accurately diagnosed.

The American Heart Association (AHA) and the American College of Cardiology (ACC) have released comprehensive new guidelines for the evaluation of chest pain.^[3]These clinical practice guidelines in the US are intended for the evaluation and diagnosis of chest pain. It provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.^[4] Similar guidelines exist in other regions, such as the European Society of Cardiology’s (ESC) guidelines for the diagnosis and management of chronic coronary syndrome and the National Institute of Care and Excellence in the UK Guideline 95.

“Patients presenting with symptoms of potential cardiovascular disease, such as chest pain, require strong care coordination to assure accurate diagnoses, care and follow-up. Additionally, effective secondary prevention and management across the care continuum is needed. GE Healthcare supports clinicians with the important diagnostic tools they need, including healthcare professionals in the ED who are in initial contact with these patients, to those who are providing specialty care,” says Eigil Samset, PhD, Chief Technology Scientist, Cardiology Care Area for GE Healthcare and Associate Professor at the University of Oslo in Norway.

Understanding the guidelines for chest pain

Guidelines are created and revised as new information arises to inform clinical practices regarding the various methods for evaluation, diagnosis and treatment. The new guidelines for the US also provide a detailed, evidence-based approach to risk-stratification and the diagnostic work-up for the evaluation of chest pain.

This structured risk-assessment promotes consistency in care, including terminology recommendations, which can prove important for establishing the patient’s history and providing ongoing care. The guidelines also provide clinicians with appropriate diagnostic testing pathways and cost-value considerations with respect to diagnostic tests. The guidelines outline specific symptoms and direction on how to select the diagnostic testing that is most likely to answer a particular question in any given scenario.

Chest pain is discomfort or pain that patients feel anywhere along the front of their body between the neck and upper abdomen.^[5] Differentiating between different types of chest pain can be difficult, so it’s important that patients share detailed information, and clinicians record the description of the chest pain in depth. For clinicians, it’s not only important to capture the detailed pain description, but also to stratify the risk for each patient, confidently, based on known risk factors as well as any comorbidities.

Heart disease can present differently in every patient. Patients are also impacted by varying risk factors such as gender, lifestyle, cultural influences, and many others. For example, heart disease has been underrecognized in women which have led to less aggressive treatment strategies and a lower representation of women in clinical trials. Experts agree that improving self-awareness in women and identification of their cardiovascular risk factors needs more attention, which should result in a better prevention of cardiovascular events.^[6]

Effective communication of chest pain descriptors and any related symptoms using the published guidelines, such as AHA/ACC Chest Pain Guideline, may lead to better utilization of testing, more accurate diagnoses and faster treatments.

Finding the right resources for diagnosing cardiovascular disease

Guidelines are useful to clinicians in order to select the appropriate diagnostic tests to find the clinical answers for patients’ symptoms. They are using diagnostic tools to help them answer questions like:

What is the likelihood of coronary artery disease?
Where in the disease progression is the patient?
Will the patient benefit from revascularization?

“When developing a care pathway approach to coronary artery disease, the key in early detection is risk assessment and to establish the probability of coronary occlusion or rule out the existence of coronary artery disease,” Samset said. “GE Healthcare is working with clinicians, offering them many options for assessing cardiac function for patients that present with atypical chest pain or symptoms of heart failure.”

One discussed diagnostic technique for the risk of developing coronary artery disease is cardiac calcium scoring with computed tomography (CT). CT calcium scoring has emerged as an easily available, consistent, and reproducible means of assessing risk for major cardiovascular outcomes, especially when planning primary prevention such as statins and aspirin regimens. In the latest AHA/ACC Chest Pain guidelines, coronary CT angiography has been given the highest recommendation (class Ia) as a first line non-invasive imaging tool for patients with intermediate-high risk. Stress testing for ischemia including cardiac Magnetic Resonance imaging (MRI), echocardiography and single-photon emission computed tomography (SPECT/CT) for myocardial perfusion imaging also have elevated recommendation (class Ib).

Chest X-rays are used to help establish potential non-cardiac causes of the patient’s pain. “To facilitate the evaluation and diagnosis of patients with chest pain who are sent for chest X-ray,” explained Samset, “GE Healthcare’s Critical Care Suite is a set of AI algorithms for automated quality checks, triage of critical findings, clinical decision support and automated measurements that helps clinicians quickly review critical cases.”

Following guidelines, such as the AHA/ACC Guideline gives clinicians a way to provide consistent care and diagnosis upon the presentation of chest pain, in addition to utilizing the right tools and resources.

“The accurate diagnosis and care for patients with cardiovascular disease often requires the review of multiple studies, current and historic, to assess for changes. Easy access to multiple modalities and previous studies is a key component of effective clinical decision making,” Samset continued. “GE Healthcare supports clinicians with the tools they need to easily access patient testing in a single cardiology jacket.”

Creating better outcomes in cardiovascular care

Along with the guidelines for evaluating chest pain to improve the consistency in diagnosis and care of cardiovascular patients, using imaging techniques effectively, and having easy access to patient health data will also contribute to better outcomes for patients with heart disease.

Raising awareness about risk factors and symptoms, patients and clinicians can improve communication and data aggregation toward a better understanding of cardiovascular diseases and how they impact patient populations. Working with industry partners such as GE Healthcare, clinicians can access the diagnostic tools they need to inform diagnoses, treatment and follow-up care. Advances in artificial intelligence (AI) solutions can facilitate clinical workflows and help optimize care pathways and outcomes for the individual patient.