The American College of Cardiology and the American Heart Association released new clinical practice guidelines on Oct. 28 for medical professionals to better identify patients who may be having a cardiac emergency, ultimately aiding in selecting the right test or treatment.

Phillip Levy, M.D., M.P.H., the Edward S. Thomas Endowed Professor of Emergency Medicine and assistant vice president of Translational Research at Wayne State, as well as chief innovation officer of Wayne Health, was vice chair of the committee that co-authored the guidelines. 

The guidelines highlighted:

• More than 6.5 million emergency department visits each year in the U.S. are due to chest pain, as well as almost 4 million outpatient clinic visits annually.
• Chest pain or discomfort can extend to the shoulders, arms, jaw, neck, back and upper abdomen.
• While most chest pain episodes are found to be not heart-related, it is the most common sign of heart trouble in advance of a serious event. People should seek immediate medical care for evaluation of chest discomfort.
• Both women and men experience chest pain during a serious heart event, however, women are more likely to experience accompanying side effects like nausea and shortness of breath.
• Shared decision-making includes the patient in conversation with health care professionals and can help ease patient concerns and reduce unnecessary testing.

According to the new guidelines, chest pain that comes on suddenly should be acted upon immediately.

“The most important thing people need to know about chest pain is that if they experience it, they should call 911,” Dr. Levy said. “People shouldn’t waste time trying to self-diagnose. They should immediately go to the nearest hospital via ambulance to get evaluated for chest pain.”

The new guidelines aim to help patients and health care professionals act faster, make smarter choices and communicate better about chest pain.

According to the study, some people may not report chest pain but rather chest discomfort, which may include pressure or tightness in the chest, but also in other areas such as the shoulders, arms, neck, back, upper abdomen or jaw. Any of these symptoms could be a sign of reduced blood flow to the heart.

“Getting care for these symptoms is urgent so that medical professionals can quickly assess the patient’s symptoms,” he said. “If the problem is a cardiac one, it can be deadly, hence the importance of seeking care quickly.”

The new guidelines outline standards to help doctors identify who is most at risk and reduce unnecessary testing in those who aren’t.

The guidance also suggests that it is critical how health care professionals talk to patients in these situations. For example, the word “atypical” is often used to describe chest pain and is often confused with noncardiac symptoms.

“This includes shared decision making,” Dr. Levy added. “It is a rethinking of conversations where doctors and patients are both participants in the decisions of what happens next – a simple concept, but one that differs from the past where the doctor tells the patient something and that’s what happens.”

The guidelines also say health care professionals should be trained to ensure they can aid people of diverse racial and ethnic backgrounds just as quickly as those of other backgrounds. In addition, it is critical to use translators when a patient does not speak English.

“The guidelines are meant to help doctors and other health care professionals make better choices faster,” he said. “These are things not to create ambiguity in the clinical world, but to create more certainty. It should give doctors more clear-cut advice that will aid in their decision-making and working with patients.”

The American Heart Association and the American College of Cardiology have partnered for more than 40 years to translate scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health.

The guideline was prepared on behalf of and approved by the American College of Cardiology and American Heart Association Joint Committee on Clinical Practice Guidelines. Five other partnering organizations participated in and approved the guideline: the American Society of Echocardiography, the American College of Chest Physicians, the Society for Academic Emergency Medicine, the Society of Cardiovascular Computed Tomography and the Society for Cardiovascular Magnetic Resonance. The writing group included representatives from each of the partnering organizations and experts in the field – cardiac intensivists, cardiac interventionalists, cardiac surgeons, cardiologists, emergency physicians and epidemiologists – and a lay/patient representative.

“Among the most important roles we as Wayne State medical faculty can play is the establishment of guidelines and treatment parameters," said School of Medicine Dean Mark E. Schweitzer, M.D. “To have one of our senior faculty lead the development of these guidelines for the most important and urgent medical issues, is a tremendous coup for our school and we are appreciative and express our admiration to Dr. Levy for leading this important committee.”

Co-authors are Dr. Levy; Vice Chair Debabrata Mukherjee, M.D., M.S., FACC, FAHA; Ezra Amsterdam, M.D., FACC; Deepak L. Bhatt, M.D., M.P.H., FACC, FAHA; Kim K. Birtcher, M.S., Pharm.D.; Ron Blankstein, M.D., FACC; Jack Boyd, M.D.; Renee P. Bullock-Palmer, M.D., FACC, FAHA; Theresa Conejo, R.N., B.S.N., FAHA; Deborah B. Diercks, M.D., M.Sc., FACC; Federico Gentile, M.D., FACC; John P. Greenwood, M.B.Ch.B., Ph.D.; Erik P. Hess, M.D., M.Sc.; Steven M. Hollenberg, M.D., FACC, FAHA; Wael A. Jaber, M.D., FACC; Hani Jneid, M.D., FACC, FAHA; José A. Joglar, M.D., FAHA, FACC; David A. Morrow, M.D., M.P.H., FACC, FAHA; Robert E. O’Connor, M.D., M.P.H., FAHA; Michael A. Ross, M.D., FACC; and Leslee J. Shaw, Ph.D., FACC, FAHA. Authors’ disclosures are listed in the manuscript.

Link to ACC.org Guideline Hub

Link to JACC.org Guideline Hub