Pain and Anxiety in Rural Acute Coronary Syndrome Patients Awaiting Transfer for Diagnostic Cardiac Catheterization: A Descriptive-Correlational Study

O'Keefe-McCarthy, Sheila Bridget

Saturday, 16 November 2013

Sheila Bridget O'Keefe-McCarthy, RN BScN MN CCNC (C)
Lawrence s. Bloomberg Faculty of Nursing, University of Toronto,, Toronto, Ontario, Central African Republic
Michael, H. McGillion, RN PhD
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto,, ON, Canada
Sioban Nelson, RN, PhD
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
Sean P. Clarke, RN, PhD, CRNP, CS
Ingram School of Nursiing, McGill University, McGill University, Montreal, QC, Canada
Judith McFetridge-Durdle, RN PhD
School of Nursing, Memorial Univsersity,, St. John’s, NF, Canada

Learning Objective 1: To discuss the trends observed in cardiac pain intensity, state anxiety and pain management during the first 8 hours of an acute coronary syndrome onset.

Learning Objective 2: To explain the evidence pertaining to the potential impact of persistent high anxiety on ACS-related cardiovascular outcomes and incorporate implications within clinical practice.

Background: In rural areas people suffering from acute coronary syndromes (ACS) wait up to 32 hours for transfer for diagnostic cardiac catheterization (CATH). In lieu of rapid access to CATH, it is critical that pain and anxiety management be optimal in order to preserve myocardial muscle and minimize the risk of further deterioration.

Aim: We examined the relationship between pain management and cardiac pain intensity and state anxiety for rural ACS patients awaiting diagnostic CATH.

Methods: A prospective, descriptive-correlational repeated-measure design was used to examine the association of cumulative analgesic administration with cardiac pain intensity (numeric rating scale-NRS) and state anxiety (Speilberger State Anxiety Inventory-SAI) via multiple variable linear mixed effects regression models.

Results: The mean age of ACS patients (n=121) was 67.6 ±13, 50% were male, 60% had unstable angina and 40% had Non-ST-Elevated myocardial infarction. During follow up, cardiac pain intensity scores remained in the mild range over 8 hours from 1.1 ± 2.2 to 2.4 ±2.7. State anxiety ranged from 44.0 ±7.2 to 46.2 ±6.6. Cumulative analgesic dose was associated with a reduction in cardiac pain by 1.0 points (NRS, 0-10) (t(108)=-2.5, SE=-0.25, CI (-0.45, -0.06), p=0.013). Analgesic administration was not associated with state anxiety. Through the course of follow up ACS patients reported high anxiety scores indicating a persistent anxious state.

Implications: Despite adequate analgesic administration anxiety scores remained high, leaving patients at risk for increased thrombus formation and lethal dysrhythmias. A larger prognostic study is required in order to determine whether high levels of anxiety for rural patients are predictive of major adverse cardiac events.

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