Impact of comorbidities by age on symptom presentation for suspected acute coronary syndromes in the emergency department

Abstract

Background It is estimated half of acute coronary syndrome (ACS) patients have one or more associated comorbid conditions. Aims Aims were to: 1) examine the prevalence of comorbid conditions in patients presenting to the emergency department with symptoms suggestive of ACS; 2) determine if comorbid conditions influence ACS symptoms; and 3) determine if comorbid conditions predict the likelihood of receiving an ACS diagnosis. Methods A total of 1064 patients admitted to five emergency departments were enrolled in this prospective study. Symptoms were measured on presentation to the emergency department. The Charlson Comorbidity Index (CCI) was used to evaluate group differences in comorbidity burden across demographic traits, risk factors, clinical presentation, and diagnosis. Results The most prominent comorbid conditions were prior myocardial infarction, diabetes without target organ damage, and chronic lung disease. In younger ACS patients, higher CCI predicted less chest pain, chest discomfort, unusual fatigue and a lower number of symptoms. In older ACS patients, higher CCI predicted more chest discomfort, upper back pain, abrupt symptom onset, and greater symptom distress. For younger non-ACS patients, higher CCI predicted less chest pain and symptom distress. Higher CCI was associated with a greater likelihood of receiving an ACS diagnosis for younger but not older patients with suspected ACS. Conclusions Younger patients with ACS and higher number of comorbidities report less chest pain, putting them at higher risk for delayed diagnosis and treatment since chest pain is a hallmark symptom for ACS.

Multimorbidity in Patients With Acute Coronary Syndrome Is Associated With Greater Mortality, Higher Readmission Rates, and Increased Length of Stay

“…This is frequently due to clinical guidelines that are based on scientific studies that focus on the primary/index disease and exclude or underrepresent multimorbid patients. 2,12,26,31,34,[36][37][38] Future studies should employ a pragmatic design and focus on health care use following discharge for ACS for patients with multimorbidity.…”

Ansiedade e desfechos clínicos em pacientes coronariopatas submetidos ao cateterismo não programado

“…(10) In another study was investigated a similar population, and a similar CCI value was found. (27) In any case, CCI is known as an adequate prognostic indicator to assess the risk of in-hospital mortality in patients with ACS after one year of the event. (25) Together, these data show the clinical severity profile of participants, whether based on the occurrence of complications after AMI or by the impact of comorbidities.…”

Preparing Chinese patients with comorbid heart disease and diabetes for home management: a mixed methods study

“…The prevalence of T2DM in patients with ACS ranges from one in four4 to more than 50% 5. Globally, patients with ACS and diabetes have more severe types of coronary lesions compared with those without diabetes 6.…”