Pharmacists Can Be Invaluable in Identifying Chest Pain

Many patients who experience chest pain are unsure whether the discomfort indicates a serious or life-threatening condition, but pharmacists can help guide them to the appropriate medications or to a physician, when necessary.¹

Chest pain is the reason for more than 6.5 million visits to the emergency department and 4 million outpatient clinic visits every year.² Individuals aged 45 to 64 years have chest pain most often, though the presentation differs between men and women.¹ Women are more likely to present with discomfort in their jaws, epigastric symptoms, and palpitations than men. Chest pain is also a common occurrence in primary care settings. Given pharmacists’ accessibility, they can serve as effective educators and help inform patients about the signs and symptoms of chest pain and the importance of taking immediate action when they experience it. Although chest pain can vary in degree of severity from a benign presentation to a life-threatening condition, it is important for patients to be aware that thorough assessments of both are necessary.³

When it comes to educating patients on the proper identification of chest pain, pharmacists can make them aware of key symptoms, including heaviness, pain, or tightness that radiates to the arms, back, jaw, and neck.³ Other notable symptoms include lightheadedness, nausea, shortness of breath, vomiting, and weakness.³ The goal of management and treatment is to help control these symptoms and reduce progression of any underlying conditions.⁴ Pharmacists can ask a few key questions about a patient’s medical history and physical condition to help evaluate the pain, but it is important to direct a patient to a physician or even an emergency department if the situation is dire. Questions to ask of patients include the characteristics and location of the chest pain, how long the symptoms have lasted, time of onset, and whether they have risk factors that predispose them to development of the chest pain.^3,4

Prior to the development of chest pain, it is important to educate patients about potential causes of chest pain, which may result from cardiac, gastrointestinal, musculoskeletal, psychological, and respiratory issues.^3,4 Each presents with unique symptoms that can alert health care professionals and patients to the severity of the presentation and whether immediate medical attention is required. For example, stable angina can present with chest pressure or heaviness that can be an indicator of a serious situation, whereas fibromyalgia that can cause widespread pain even to the anterior chest may not be as time sensitive in terms of seeking care.

Pharmacists are invaluable members of the health care team in terms of chest pain identification and management because they can provide interventions by offering advice on drug information and instructions for the use of medications that target chest pain.⁵ Additionally, pharmacists can provide counseling to patients who are taking medications to address their specific chest pain. Research findings have shown that the involvement of pharmacists in the multidisciplinary team has been able to reduce morbidity and mortality rates.^4,6 The involvement of pharmacists in education related to chest pain and the identification of its symptoms can have a significant impact on the quality of care delivered to patients.

Abimbola Farinde, PhD, PharmD, is a professor of health care administration at Columbia Southern University College of Business in Orange Beach, Alabama.

Reference

1. Harskamp RE, Laeven SC, Himmelreich JC, Lucassen WAM, van Weert HCP. Chest pain in general practice: a systematic review of prediction rules. BMJ Open. 2019;9(2):e027081. doi:10.1136/bmjop-en-2018-027081

2. 2021 chest pain guideline. CardioSmart. October 28, 2021. Accessed November 15, 2021. https://www.cardiosmart.org/news/2021/10/2021-chest-pain-guideline

3. Gibson JL. Evaluating and treating chest pain in the acute care setting. US Pharm. 2011;36(5):HS-15-HS-26.

4. Sagita VA, Bahtiar A, Andrajati R. Evaluation of a clinical pharmacist intervention on clinical and drug-related problems among coronary heart disease inpatients: a pre-experimental prospective study at a general hospital in Indonesia. Sultan Qaboos Univ Med J. 2018;18(1):e81-e87. doi:10.18295/squmj.2018.18.01.013

5. Abraham RR. Drug related problems and reactive pharmacist interventions for inpatients receiving cardiovascular drugs. Int J Basic Med Sci Pharm. 2013;3(2):42-48.

6. Gattis WA, Hasselblad V, Whellan DJ, O’Connor CM. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study. Arch Intern Med. 1999;159(16):1939-1945. doi:10.1001/ archinte.159.16.1939