Symptom predictors of acute coronary syndromes in younger and older patients

Background: Symptoms, a key element in the patient's decision to seek care, are critical to appropriate triage, and influence decisions to pursue furt her evaluation and initiation of treatment. Although many studies have desc ribed symptoms associated with acute coronary syndromes (ACS), few, if any, have examined symptom predictors of ACS and whether they differ by patient s' age. Objectives: To explore symptom predictors of ACS in younger (< 70 years) an d older ( 70 years) patients. To test the hypothesis that typical symptoms are predictive of ACS in younger patients, but are less predictive in older patients. Method: Secondary analysis of observational data gathered on 531 patients p resenting to the emergency department of a regional cardiac referral center in Flew England with symptoms suggestive of ACS. Results: Bivariate analyses revealed no symptoms significantly (p < .01) as sociated with ACS in older patients. In younger patients presence of chest symptoms and the total number of typical symptoms reported were significant ly (p < .01) associated with ACS. After adjustment for age and gender, typi cal symptoms that were positive predictors of ACS in younger patients inclu ded chest symptoms (OR 2.37, 95% CI 1.32-4.27, p = .004) and arm pain (OR 1 .78, 95% CI 1.03-3.09, p = .040). Additionally, the total number of typical symptoms reported (OR 1.68, 95% CI 1.31-2.15, p < .001) was a positive pre dictor of ACS in younger patients. The atypical symptom of fatigue (OR 2.52 , 95% Cl 1.10-5.81, p = .029) was a significant positive predictor of ACS, whereas dizziness/faintness (OR.50, 95% Cl.26-.91, p = .024) was a signific ant negative predictor of ACS in younger patients. Logistic regression anal ysis using the entire sample revealed an interaction between age and number of typical symptoms indicating that younger patients had a 36% greater odd s for ACS for each additional typical symptom present compared with older p atients (OR 1.36, 95% CI 1.02-1.83, p = .038 for interaction between age an d number of typical symptoms reported). The model with the interaction betw een age and chest symptoms revealed a borderline association (p = .10 for t he interaction between age and chest symptoms), with younger patients being more likely than older patients to report chest symptoms. Conclusions: Typical symptoms are predictive of ACS in younger patients and less predictive in older patients.