Is family history of coronary artery disease important in the emergency department triage?

Objective: To explore the role of family history (FH) as a risk factor for ST elevation myocardial infarction (STEMI) in the emergency department (ED) setting during nurse triage and to analyze the clinical outcomes and time lags of patients with and without FH of coronary artery disease (CAD).

Methods: A retrospective archive study was conducted in 2017 in a public tertiary ED at an academic teaching hospital. Data were collected from the electronic medical record for the period of January 2015 to December 2016 on STEMI patients. Of the 335 patients identified with STEMI we included 140 (41.8%) who were eligible to the study inclusion criteria and treated at the ED. Patients transferred directly to the catheterization lab were excluded. We collected and compared information from nurse and physician records on known risk factors for STEMI in adherence to American Heart Association guidelines and hospital outcomes between patients with and without FH of CAD. Logistic regressions were performed to identify the contribution of each risk factor on hospital outcomes.

Results: A negligible number of triage nurses documented if the patient had a FH compared to physicians (5.7% vs. 98.8%). Patients with and without FH of CAD were similarly evaluated at ED triage. However, patients with FH transferred earlier to the catheterization lab and had lower hospital readmission rates. Logistic regression analysis showed that FH is a protective factor for ED revisit for general and cardiac reasons.

Conclusion: There is a need to retrieve information on FH of CAD for all patients presenting with symptoms suggestive of STEMI at ED triage.