Retrospective study of elderly frequent attenders presenting with chest pain at emergency department

Abstract

BackgroundThe aims of the study were to identify the characteristics of elderly frequent attenders to the emergency department (ED) presenting with chest pain and to assess the 1-year prognosis for developing adverse cardiac events.FindingsPatients over 75 years old, with four or more attendances to the ED between 1 January 2010 and 31 December 2010 with at least one attendance due to chest pain, were selected from a database. Data was collected on demographic details, visit history, disposition and admission outcomes. Each patient was followed up for 12 months after the index episode via the hospital electronic registry for adverse cardiac outcome. Adverse cardiac outcomes included death from cardiac event, acute myocardial infarction (ST elevation myocardial infarction (STEMI)/non-ST elevation myocardial infarction (NSTEMI)) or unstable angina. A total of 158 patients with 4 or more visits to the ED accounted for 290 visits with chest pain during 2010. There is a high prevalence of coronary risk factors in this cohort (hypertension 92.4%, hyperlipidaemia 65.2%, diabetes 49.4% and smoking 26.6%). The hospital admission rate was also high at 83.5%. Over the ensuing 12 months, 8 patients died of a primary cardiac event and a further 29 patients developed 36 non-fatal cardiac events. We could not establish any significant relationship between increase in adverse cardiac outcome and individual risk factors or even two or more risk factors (P = 0.0572). Patients with two or more attendances with chest pain were more likely to develop adverse cardiac outcome (P = 0.0068).ConclusionsElderly frequent attenders to the ED, who present with chest pain, have more cardiac risk factors and are more likely to develop adverse coronary outcomes if they re-attend with chest pain.

Factors driving frequent attendance at emergency departments for patients with head and neck cancer

“…In this study, we found that these factors associated with an increased risk of FA status: lower SES (housing subsidy type) and greater comorbidity. This was similar to the findings from other studies …”

“…Studies have shown FAs to have a higher chronic disease burden, lower SES, and higher utilization of nonemergency health care services . In a previous national cohort study, we found that certain cancer profiles increased the risk of ED FA: head and neck cancers were up to twice as likely to be an FA …”

“…This was similar to the findings from other studies. 3,[6][7][8][9][10][11] Before this study, we had postulated that FAs presented with different issues compared to non-FAs. We found that FAs had a greater proportion of respiration-related diagnoses (mostly contributed by respiratory infections) and general or nonspecific symptoms compared to non-FAs, who presented more often for neoplasm-related diagnoses.…”

Cancer patients as frequent attenders in emergency departments: A national cohort study

“…[9][10][11][12][13] A smaller cohort of cancer patients return to the ED multiple times, and become ED frequent attenders (FA), commonly defined as patients making four or more visits within a 12-month period. [14][15][16][17][18] Studies that examine general ED patients have shown that FAs have a higher chronic disease burden, different socioeconomic profiles, 14,[17][18][19][20] and higher utilization of nonemergent healthcare services. 15,16 Yet, little is known about cancer patients who become FAs.…”

Intervention Study with Algoplus®: A Pain Behavioral Scale for Older Patients in the Emergency Department

“…Admissions to the Emergency Department (ED) are continuously rising, and it is estimated that 50% to 80% of ED presentations are associated with acute pain . Older persons are admitted to the ED more than younger patients, with people aged ≥ 85 years being 4 times as likely to present than those aged 35 to 59 years .…”