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  1. Z Hassanali,
  2. IA Sammy,
  3. JF Paul,
  4. R Sinanan
  1. Faculty of Medical Sciences, The University of the West Indies, Sale, UK


    Objectives & Background Acute Coronary Syndrome (ACS) is a major cause of mortality in Trinidad and Tobago. Previous studies have demonstrated differences in the presenting symptoms between older and younger patients with ACS. However, to our knowledge, no such work has been done on older patients in the developing world.

    The aim of this study was to determine the differences in the reported symptoms of ACS between the older patients (age≥65) and younger adults (age 18–64) in the ED. A secondary objective was to determine if differences in reported symptoms also exist between men and women.

    Methods A retrospective cross-sectional study of all adult patients admitted to the ED of the San Fernando General Hospital with a discharge diagnosis of ACS from August 1, 2012–May 31, 2013 was conducted. Elderly patient symptoms were compared with other adult patients using descriptive and analytic methods. Symptoms were similarly compared between males and females. Symptoms were compared using odds ratios. All results were presented with 95% confidence intervals and ‘p’ values.

    Results The symptoms of 1148 adult patients with ACS were analyzed. The mean age of presentation was 61.6 years (SD12.2). 41.3% of patients were elderly and 47.0% were males. Syncope (OR 2.1; 95% CI 1.1, 3.7), Paroxysmal Nocturnal Dyspnea [PND] (OR 1.3; 95% CI 1.0, 1.7) and orthopnea (OR 1.3, 95% CI 1.0, 1.6) were more likely to be reported in the elderly while chest pain on exertion (OR 0.7; 95% CI 0.5, 0.9) and chest pain in the past 24 hours (OR 0.8; 95% CI 0.6, 1.0) were less likely to be reported in the elderly. Females were more likely to report shortness of breath (SOB) at rest (OR 1.4; 95% CI 1.1, 1.8), PND (OR 1.8; 95% CI 1.3, 2.4), orthopnea (OR 2.0; 95% CI 1.6, 2.7), palpitations (OR 1.7; 95% CI 1.3, 2.2), and nausea (OR 1.5; 95% CI 1.2, 1.9) than males. Chest pain at rest was still the most frequent symptom reported in all groups.

    Conclusion This study demonstrates significant differences in symptoms between older and younger patients as well as between men and women. Clinical assessment of older patients with ACS should be tailored to their common presenting features. Further work is needed to develop a clinical assessment tool for older patients with ACS that accounts for differences in presentation.

    • emergency departments

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