The Impact Of Circadian And Weekly Variation On Evaluation And Treatment In Acute Chest Pain Patients Of A Tertiary General Hospital

Objective:To study the time for presentation of chest pain patients in the emergency department, and the differences in epidemiological characteristics, auxiliary tests, treatments, triage of patients vary from the time for presentation.Methods:We conducted a prospective registry study in an emergency department of a tertiary general hospital in Shandong Province from October 1st,2014 to August 23rd,2015. Patients were included if they had chest pain and chest pain equivalent syndromes onset within 24 hours and the informed consent form was signed when the patient was more than 18 years old. We exclude the patient if the pain was caused by trauma, connective tissue diseases or tumor.Data were collected by research nursing staff with standard Case Report Form and a database was funded based on computer. Patients were stratified by time for presentation. The normal distribution of continuous variables were presented by mean±SD, and median was used if the distribution was non-normal. All statistics analyses were conducted with SAS (version 9.4).Results:A total 1991 chest pain patients were enrolled in the study.1. Time for presenting:Most of the chest pain patients presented from 8am to 12pm, only 17.48% patients presented from 0am to 8am. The daily average rate between workday and weekend was almost the same, which was 6.12 and 6.00 respectively.2. Epidemiological characteristics:Less of chest pain patients presented from 4pm to 12pm who were more than 65 years old than that presented from 8am to 4pm and that presented from 0am to 8am (P<0.05). Less of chest pain patients presented from 4pm to 12pm who had hypertension than that presented from 8am to 4pm and that presented from 0am to 8am (P<0.05). Less of chest pain patients presented on workdays who had CABG than that presented on weekends (P< 0.05).3. Auxiliary tests:The percentage of patients who received ECG and presented from Oam to 8am was higher than that of patients who received ECG and presented from 8am to 4pm and that of patients who received ECG and presented from 4pm to 12pm.4. Treatments:The percentage of patients who received medication and presented from 4pm to 12pm was higher than that of patients who received medication and presented from 0am to 8am and that of patients who received medication and presented from 8am to 4pm (P<0.05). The percentage of STEMI patients who presented on weekends was higher than that of STEMI patients who presented on workdays (P<0.05).5. Triage:More patients were discharged home when they presented from 8am to 4pm than other time (P<0.05). The patients stayed on the ED which was more than 6 hours if they presented from 8am to 4pm were less than that in other time (P<0.05).Conclusions:1. The time for presentation of chest pain patients was related to age, race, known hypertension, history of CABG, time of cardiac biomarker to door, use of Chinese patent medicine, residence time and triage.2. We have to further standardize the treatment of the acute chest pain patients, especially the auxiliary examination, emergency treatment, and triage presented of the off-business time.3. The residence time of most patients was more than 6 hours. We should speed up the emergency triage and reduce the emergency traffic.