Impact of comorbidities by age on symptom presentation for suspected acute coronary syndromes in the emergency department.
Larisa A Burke, Anne G Rosenfeld, Mohamud R Daya and 6 others
PMID 28198635WHAT IT FOUND
In patients assessed for possible acute coronary syndrome in the emergency department, more chronic conditions were linked to fewer chest symptoms in younger patients and to a higher chance of an ACS diagnosis.
Key findings
01Comorbidity burden predicted an ACS diagnosis only in younger patients, specifically at ages 40 to 50 years, and increased the likelihood under age 60.
02Younger patients with ACS were less likely to report chest discomfort, chest pain, and unusual fatigue as comorbidity burden increased.
03Older patients with ACS were more likely to report chest discomfort and upper back pain, abrupt symptom onset, and greater distress as comorbidity burden increased.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only patients whom emergency department nurses and physicians considered at risk for ACS were enrolled, and recruitment targeted elevated troponin, so patients with less obvious presentations may be missing. Enrolment occurred only from 07:00 to 23:00, so overnight emergency department presentations were not represented. 28.7% of eligible patients approached declined to participate, citing fatigue, anxiety, or lack of interest. The study is observational, so it cannot show that comorbid conditions caused changes in symptom reporting or diagnosis. Comorbidity data were missing for three participants.
The easy way to misread this
Do not read comorbidity burden as a stand-alone emergency department triage tool. It predicted an acute coronary syndrome diagnosis only in younger patients, and the authors state it added little to risk stratification on arrival.