title: Symptom predictors of acute coronary syndromes in younger and older patients.
abstract: BACKGROUND
  Symptoms, a key element in the patient's decision to seek care, are critical to appropriate triage, and influence decisions to pursue further evaluation and initiation of treatment. Although many studies have described symptoms associated with acute coronary syndromes (ACS), few, if any, have examined symptom predictors of ACS and whether they differ by patients' age.
  
  
  OBJECTIVE
  To explore symptom predictors of ACS in younger (< 70 years) and older (> or = 70 years) patients. To test the hypothesis that typical symptoms are predictive of ACS in younger patients, but are less predictive in older patients.
  
  
  METHODS
  Secondary analysis of observational data gathered on 531 patients presenting to the emergency department of a regional cardiac referral center in New England with symptoms suggestive of ACS.
  
  
  RESULTS
  Bivariate analyses revealed no symptoms significantly (p < .01) associated with ACS in older patients. In younger patients presence of chest symptoms and the total number of typical symptoms reported were significantly (p < .01) associated with ACS. After adjustment for age and gender, typical symptoms that were positive predictors of ACS in younger patients included 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 predictor of ACS in younger patients. The atypical symptom of fatigue (OR 2.52, 95% CI 1.10-5.81, p = .029) was a significant positive predictor of ACS, whereas dizziness/faintness (OR .50, 95% CI .26-.91, p = .024) was a significant negative predictor of ACS in younger patients. Logistic regression analysis using the entire sample revealed an interaction between age and number of typical symptoms indicating that younger patients had a 36% greater odds for ACS for each additional typical symptom present compared with older patients (OR 1.36, 95% CI 1.02-1.83, p = .038 for interaction between age and number of typical symptoms reported). The model with the interaction between age and chest symptoms revealed a borderline association (p = .10 for the 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.
authors.affiliation: Yale University School of Nursing, New Haven, Connecticut 06536-0740, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Milner
authors.forename: M
authors.initials: M
authors.lastname: Funk
authors.forename: S
authors.initials: S
authors.lastname: Richards
authors.forename: V
authors.initials: V
authors.lastname: Vaccarino
authors.forename: H M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D002637:Chest Pain / Q000209:etiology*; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis / Q000451:nursing; D004244:Dizziness / Q000209:etiology*; D004417:Dyspnea / Q000209:etiology; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009325:Nausea / Q000209:etiology; D009730:Nursing Assessment; D011237:Predictive Value of Tests; D012307:Risk Factors; D013575:Syncope / Q000209:etiology*; D014839:Vomiting / Q000209:etiology