Higher Frequency of Undetected Acute Coronary Syndrome in Elderly Patients with Chest Pain Who Visited the Emergency Department: A Large-Cohort Retrospective Study.

Ki Hun Hong,Yoon Hee Choi,Sangsoo Han,Duk Ho Kim,Sang Hyun Park,Choung Ah Lee,Sung Jin Bae,Dong Hoon Lee,Jee Yong Lim,Eui Chung Kim,Cheol Lee

doi:10.1155/2021/6611051

Abstract

Background Acute coronary syndrome (ACS) is a critical disease encountered in the emergency department (ED). Despite the development of diagnostic tools, it may be difficult to diagnose ACS because of atypical symptoms and equivocal test results. We investigated the difference in the rates of revisit and undetected ACS between adult and elderly patients who visited the ED with chest pain. Method Data from 11,323 patients who visited the ED with chest pain at university hospitals in Korea were retrospectively analyzed. The cohort was categorized into two age groups: the adult (30–64 years) and elderly (>65 years). Baseline characteristic data (age, sex, vital signs, triage category, etc.) were obtained. We selected patients who revisited the ED within 30 d and investigated whether ACS was diagnosed. Result The revisit rate was higher in the elderly (12%) than in the adult group (8.3%). The rate of undetected ACS among the revisited patients was 2.91% (18/7,186) in adults and 6.08% (16/1,998) in elderly patients. Conclusion Elderly patients with chest pain had an increased rate of ED revisits and undetected ACS than adult patients. We recommend that old patients should be hospitalized to observe the progression of cardiac complaints or receive short-term follow-up.

Highlights

Acute coronary syndrome (ACS) is one of the critical diseases encountered in the emergency department (ED)
After extracting the patients’ data from the National Emergency Department Information System (NEDIS) database, we reviewed the electronic medical records (EMR) of patients with undetected ACS to investigate the results of examinations, such as ECG, troponin, and coronary angiography (CAG), and the reason for the revisit
Among the 8,563 patients who were in the age group of 30–64 years and had a complaint of chest pain on the index ED visit, 18 patients were not diagnosed with ACS on their index ED visit, but ACS was confirmed on ED revisit within 30 d from the index visit

Summary

Introduction

When patients visit the ED with chest pain, emergency physicians (EPs) should assess the chief complaints and include ACS in the differential diagnosis. Some patients present with atypical symptoms and equivocal results, making diagnosis difficult. Despite the development of diagnostic tools, it may be difficult to diagnose ACS because of atypical symptoms and equivocal test results. We investigated the difference in the rates of revisit and undetected ACS between adult and elderly patients who visited the ED with chest pain. The revisit rate was higher in the elderly (12%) than in the adult group (8.3%). The rate of undetected ACS among the revisited patients was 2.91% (18/7,186) in adults and 6.08% (16/1,998) in elderly patients. Patients with chest pain had an increased rate of ED revisits and undetected ACS than adult patients. We recommend that old patients should be hospitalized to observe the progression of cardiac complaints or receive short-term follow-up

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Conclusion