Symptom predictors of acute coronary syndromes in younger and older patients

Abstract

Background: Symptoms, a key element in the patient's decision to seek care, are critical to appropriate triage, and influence decisions to pursue further evaluation and initiation of treatment. Although many studies have described symptoms associated with acute coronary syndromes (ACS), few, if any, have examined symptom predictors of ACS and whether they differ by patients' age. Objectives: To explore symptom predictors of ACS in younger (< 70 years) and older (≥ 70 years) patients. To test the hypothesis that typical symptoms are predictive of ACS in younger patients, but are less predictive in older patients. Method: Secondary analysis of observational data gathered on 531 patients presenting to the emergency department of a regional cardiac referral center in New England with symptoms suggestive of ACS. Results: Bivariate analyses revealed no symptoms significantly (p < .01) associated with ACS in older patients. In younger patients presence of chest symptoms and the total number of typical symptoms reported were significantly (p < .01) associated with ACS. After adjustment for age and gender, typical symptoms that were positive predictors of ACS in younger patients included chest symptoms (OR 2.37, 95% Cl 1.32-4.27, p = .004) and arm pain (OR 1.78, 95% Cl 1.03-3.09, p = .040). Additionally, the total number of typical symptoms reported (OR 1.68, 95% Cl 1.31-2.15, p