Explanatory Factors Of Pain Among Patients With Heart Failure Transported By Emergency Medical Services

Abstract

<h3>Introduction</h3> Pain is a common symptom in heart failure (HF) that often causes patients to activate emergency medical services (EMS). However, the factors associated with pain presence and severity remains unknown among patients with HF. The aims of this study were to determine explanatory factors of (1) presenting to EMS with a primary complaint of pain and (2) a higher severity of pain. <h3>Methods</h3> This study analyzed cross-sectional point of care data from EMS electronic health records of 6,982 HF patients who were transported by EMS within a midwestern US county. These data were previously collected in a parent study. Multiple linear regression and logistic regression were used to evaluate factors associated with presenting with a primary complaint of pain and higher pain severity. Demographic explanatory factors were age, sex, and self-reported race. Clinical explanatory factors were vital signs, number of medications, and comorbid conditions. <h3>Results</h3> The sample was 57.6% female and 42.4% male. Self-reported race was 57.7% Black, 41.4% White, and 0.9% other. Mean age was 64.2 years (SD 14.5). Of the 6,982 patients, 1,494 patients (21.4%) presented to EMS with a primary complaint of pain. Pain severity was recorded for 405 patients who presented with a primary complaint of pain using a scale of 0-10 (10 being the worst possible pain) and mean pain severity scores in this subsample was 6.8 (SD 3.04). For aim 1, statistically significant factors associated with presenting to EMS with a primary complaint of pain were female sex (OR=1.14, p=0.04), younger age (OR=0.97, p<0.001), history of coronary artery disease (OR=1.34, p=0.002), myocardial infarction (OR=2.22, p<0.001) or coronary artery bypass graft (OR=1.31, p=0.05), and absence of shortness of breath (OR=0.76, p<0.001). Race, number of medications, presence of a pacemaker, and atrial fibrillation were not statistically significant. For aim 2, statistically significant factors associated with higher pain severity included younger age (beta=-0.47, p<0.001), female sex (beta=1.17, p=0.001), Black race (beta=-1.1, p=0.002), and higher systolic blood pressure (beta=0.13, p=0.012). Other vital signs, comorbid conditions, number of medications, and devices were not statistically significant. <h3>Conclusions</h3> Among patients with HF, younger age, female sex, and history of heart conditions (i.e., coronary artery disease, myocardial infarction, coronary artery bypass graft) were associated with activation of EMS services for pain, and Black race was associated with lower pain severity. History of myocardial infarction was the largest explanatory factor of presenting with pain. Longitudinal research is needed to explore if these factors can predict pain presence and severity, and if pain is associated with multiple transports.