title: Retrospective study of elderly frequent attenders presenting with chest pain at emergency department.
abstract: BACKGROUND
  The aims of the study were to identify the characteristics of elderly frequent attenders to the emergency department (ED) presenting with chest pain and to assess the 1-year prognosis for developing adverse cardiac events.
  
  
  RESULTS
  Patients over 75 years old, with four or more attendances to the ED between 1 January 2010 and 31 December 2010 with at least one attendance due to chest pain, were selected from a database. Data was collected on demographic details, visit history, disposition and admission outcomes. Each patient was followed up for 12 months after the index episode via the hospital electronic registry for adverse cardiac outcome. Adverse cardiac outcomes included death from cardiac event, acute myocardial infarction (ST elevation myocardial infarction (STEMI)/non-ST elevation myocardial infarction (NSTEMI)) or unstable angina. A total of 158 patients with 4 or more visits to the ED accounted for 290 visits with chest pain during 2010. There is a high prevalence of coronary risk factors in this cohort (hypertension 92.4%, hyperlipidaemia 65.2%, diabetes 49.4% and smoking 26.6%). The hospital admission rate was also high at 83.5%. Over the ensuing 12 months, 8 patients died of a primary cardiac event and a further 29 patients developed 36 non-fatal cardiac events. We could not establish any significant relationship between increase in adverse cardiac outcome and individual risk factors or even two or more risk factors (P = 0.0572). Patients with two or more attendances with chest pain were more likely to develop adverse cardiac outcome (P = 0.0068).
  
  
  CONCLUSIONS
  Elderly frequent attenders to the ED, who present with chest pain, have more cardiac risk factors and are more likely to develop adverse coronary outcomes if they re-attend with chest pain.
authors: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
authors: Faraz
authors: F
authors: Zarisfi
authors: Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.
authors: Qi En
authors: QE
authors: Hong
authors: Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.
authors: Pauline See Joon
authors: PS
authors: Seah
authors: Health Services Research Unit, Division of Research, Singapore General Hospital, 226 Outram Road Blk A Level 2, Singapore 169039, Singapore.
authors: Huihua
authors: H
authors: Li
authors: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
authors: Susan
authors: S
authors: Yap
authors: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
authors: Marcus Eng Hock
authors: ME
authors: Ong
keywords: Chest pain; Elderly; Emergency department; Frequent attenders
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