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The elder patient with suspected acute coronary syndromes in the emergency department.
Acad Emerg Med. 2007 Aug; 14(8):732-9.AE

Abstract

OBJECTIVES

To describe the evaluation and outcomes of elder patients with suspected acute coronary syndromes (ACS) presenting to the emergency department (ED).

METHODS

This was a post hoc analysis of the Internet Tracking Registry for Acute Coronary Syndromes (i*trACS) registry, which had 17,713 ED visits for suspected ACS. First visits from the United States with nonmissing patient demographics, 12-lead electrocardiogram results, and clinical history were included in the analysis. Those who used cocaine or amphetamines or left the ED against medical advice were excluded. Elder was defined as age 75 years or older. ACS was defined by 30-day revascularization, Diagnosis-related Group codes, or death within 30 days with positive cardiac biomarkers at index hospitalization. Multivariable logistic regression analyses were performed to determine the association between being elder and 1) 30-day all-cause mortality, 2) ACS, 3) diagnostic tests ordered, and 4) disposition. Multivariable logistic regression was also performed to determine which clinical variables were associated with ACS in elder and nonelder patients.

RESULTS

A total of 10,126 patients with suspected ACS presenting to the ED were analyzed. For patients presenting to the ED, being elder was independently associated with ACS and all-cause 30-day mortality, with adjusted odds ratios of 1.8 (95% confidence interval [CI] = 1.5 to 2.2) and 2.6 (95% CI = 1.6 to 4.3), respectively. Elder patients were more likely to be admitted to the hospital (adjusted odds ratio, 2.2; 95% CI = 1.8 to 2.6), but there were no differences in the rates of cardiac catheterization and noninvasive stress cardiac imaging. Different clinical variables were associated with ACS in elder and nonelder patients. Chest pain as chief complaint, typical chest pain, and previous history of coronary artery disease were significantly associated with ACS in nonelder patients but were not associated with ACS in elder patients. Male gender and left arm pain were associated with ACS in both elder and nonelder patients.

CONCLUSIONS

Elder patients who present to the ED with suspected ACS represent a population at high risk for ACS and 30-day mortality. Elders are more likely to be admitted to the hospital, but despite an increased risk for adverse events, they have similar odds of receiving a diagnostic test, such as stress cardiac imaging or cardiac catheterization, compared with nonelder patients. Different clinical variables are associated with ACS, and clinical prediction rules utilizing presenting symptoms should consider the effect modification of age.

Authors+Show Affiliations

Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. jin.h.han@vanderbilt.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17567963

Citation

Han, Jin H., et al. "The Elder Patient With Suspected Acute Coronary Syndromes in the Emergency Department." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 14, no. 8, 2007, pp. 732-9.
Han JH, Lindsell CJ, Hornung RW, et al. The elder patient with suspected acute coronary syndromes in the emergency department. Acad Emerg Med. 2007;14(8):732-9.
Han, J. H., Lindsell, C. J., Hornung, R. W., Lewis, T., Storrow, A. B., Hoekstra, J. W., Hollander, J. E., Miller, C. D., Peacock, W. F., Pollack, C. V., & Gibler, W. B. (2007). The elder patient with suspected acute coronary syndromes in the emergency department. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 14(8), 732-9.
Han JH, et al. The Elder Patient With Suspected Acute Coronary Syndromes in the Emergency Department. Acad Emerg Med. 2007;14(8):732-9. PubMed PMID: 17567963.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The elder patient with suspected acute coronary syndromes in the emergency department. AU - Han,Jin H, AU - Lindsell,Christopher J, AU - Hornung,Richard W, AU - Lewis,Timothy, AU - Storrow,Alan B, AU - Hoekstra,James W, AU - Hollander,Judd E, AU - Miller,Chadwick D, AU - Peacock,W Frank, AU - Pollack,Charles V, AU - Gibler,W Brian, AU - ,, Y1 - 2007/06/13/ PY - 2007/6/15/pubmed PY - 2007/9/12/medline PY - 2007/6/15/entrez SP - 732 EP - 9 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 14 IS - 8 N2 - OBJECTIVES: To describe the evaluation and outcomes of elder patients with suspected acute coronary syndromes (ACS) presenting to the emergency department (ED). METHODS: This was a post hoc analysis of the Internet Tracking Registry for Acute Coronary Syndromes (i*trACS) registry, which had 17,713 ED visits for suspected ACS. First visits from the United States with nonmissing patient demographics, 12-lead electrocardiogram results, and clinical history were included in the analysis. Those who used cocaine or amphetamines or left the ED against medical advice were excluded. Elder was defined as age 75 years or older. ACS was defined by 30-day revascularization, Diagnosis-related Group codes, or death within 30 days with positive cardiac biomarkers at index hospitalization. Multivariable logistic regression analyses were performed to determine the association between being elder and 1) 30-day all-cause mortality, 2) ACS, 3) diagnostic tests ordered, and 4) disposition. Multivariable logistic regression was also performed to determine which clinical variables were associated with ACS in elder and nonelder patients. RESULTS: A total of 10,126 patients with suspected ACS presenting to the ED were analyzed. For patients presenting to the ED, being elder was independently associated with ACS and all-cause 30-day mortality, with adjusted odds ratios of 1.8 (95% confidence interval [CI] = 1.5 to 2.2) and 2.6 (95% CI = 1.6 to 4.3), respectively. Elder patients were more likely to be admitted to the hospital (adjusted odds ratio, 2.2; 95% CI = 1.8 to 2.6), but there were no differences in the rates of cardiac catheterization and noninvasive stress cardiac imaging. Different clinical variables were associated with ACS in elder and nonelder patients. Chest pain as chief complaint, typical chest pain, and previous history of coronary artery disease were significantly associated with ACS in nonelder patients but were not associated with ACS in elder patients. Male gender and left arm pain were associated with ACS in both elder and nonelder patients. CONCLUSIONS: Elder patients who present to the ED with suspected ACS represent a population at high risk for ACS and 30-day mortality. Elders are more likely to be admitted to the hospital, but despite an increased risk for adverse events, they have similar odds of receiving a diagnostic test, such as stress cardiac imaging or cardiac catheterization, compared with nonelder patients. Different clinical variables are associated with ACS, and clinical prediction rules utilizing presenting symptoms should consider the effect modification of age. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/17567963/The_elder_patient_with_suspected_acute_coronary_syndromes_in_the_emergency_department_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1069-6563&date=2007&volume=14&issue=8&spage=732 DB - PRIME DP - Unbound Medicine ER -