Multimorbidity phenotypes in patients presenting to the emergency department with possible acute coronary syndrome.
Katherine M Breen, Lorna Finnegan, Karen M Vuckovic and 3 others
PMID 34098234WHAT IT FOUND
Among emergency department patients evaluated for possible acute coronary syndrome, four chronic-condition patterns emerged.
Cardiovascular and cardiovascular-oncologic patterns were associated with an ACS diagnosis; having many conditions overall was not.
Key findings
01Patients were grouped into four multimorbidity classes: high multimorbidity, low multimorbidity, cardiovascular multimorbidity, and cardiovascular-oncologic multimorbidity.
02The cardiovascular multimorbidity and cardiovascular-oncologic multimorbidity classes were associated with being ruled-in for ACS compared with the low multimorbidity class.
03The high multimorbidity class was not significantly associated with an ACS diagnosis compared with the low multimorbidity class.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study only looked at patients who already had high-risk features for ACS, such as an abnormal ECG or positive troponin, so it does not show how these patterns apply to lower-risk chest pain patients. It was a secondary analysis of an existing dataset, not a prospective test of a new risk-stratification tool. The outcome was being ruled-in or ruled-out for ACS in that dataset, not mortality, readmission, length of stay, or other patient outcomes. Conditions were counted as present or absent, without severity, cancer type, or current versus previous cancer. Some conditions, including lupus and peripheral vascular disease, were too rare for adequate analysis. The final analysed sample was smaller than the initial condition-data sample because patients needed complete covariate data.
Declared interests
The paper lists NIH extramural research support. It does not include a separate conflicts-of-interest statement.
The easy way to misread this
Do not use these phenotypes as a validated ED triage tool. The study is exploratory and shows association with ACS diagnosis, not that the phenotypes caused ACS or that they improve patient outcomes.