title: Impact of comorbidities by age on symptom presentation for suspected acute coronary syndromes in the emergency department.
abstract: BACKGROUND
  It is estimated half of acute coronary syndrome (ACS) patients have one or more associated comorbid conditions.
  
  
  OBJECTIVE
  Aims were to: 1) examine the prevalence of comorbid conditions in patients presenting to the emergency department with symptoms suggestive of ACS; 2) determine if comorbid conditions influence ACS symptoms; and 3) determine if comorbid conditions predict the likelihood of receiving an ACS diagnosis.
  
  
  METHODS
  A total of 1064 patients admitted to five emergency departments were enrolled in this prospective study. Symptoms were measured on presentation to the emergency department. The Charlson Comorbidity Index (CCI) was used to evaluate group differences in comorbidity burden across demographic traits, risk factors, clinical presentation, and diagnosis.
  
  
  RESULTS
  The most prominent comorbid conditions were prior myocardial infarction, diabetes without target organ damage, and chronic lung disease. In younger ACS patients, higher CCI predicted less chest pain, chest discomfort, unusual fatigue and a lower number of symptoms. In older ACS patients, higher CCI predicted more chest discomfort, upper back pain, abrupt symptom onset, and greater symptom distress. For younger non-ACS patients, higher CCI predicted less chest pain and symptom distress. Higher CCI was associated with a greater likelihood of receiving an ACS diagnosis for younger but not older patients with suspected ACS.
  
  
  CONCLUSIONS
  Younger patients with ACS and higher number of comorbidities report less chest pain, putting them at higher risk for delayed diagnosis and treatment since chest pain is a hallmark symptom for ACS.
authors.affiliation: 1 Department of Biobehavioral Sciences, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Larisa A
authors.initials: LA
authors.lastname: Burke
authors.affiliation: 2 Biobehavioral Health Science Division, University of Arizona College of Nursing, Tucson, AZ, USA.
authors.forename: Anne G
authors.initials: AG
authors.lastname: Rosenfeld
authors.affiliation: 3 Department of Emergency Medicine, Oregon Health & Sciences University, Portland, OR, USA.
authors.forename: Mohamud R
authors.initials: MR
authors.lastname: Daya
authors.affiliation: 1 Department of Biobehavioral Sciences, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Vuckovic
authors.affiliation: 4 School of Nursing, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Zegre-Hemsey
authors.affiliation: 1 Department of Biobehavioral Sciences, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Felix Diaz
authors.affiliation: 1 Department of Biobehavioral Sciences, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Josemare
authors.initials: J
authors.lastname: Tosta Daiube Santos
authors.affiliation: 1 Department of Biobehavioral Sciences, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Sahereh
authors.initials: S
authors.lastname: Mirzaei
authors.affiliation: 1 Department of Biobehavioral Sciences, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Holli A
authors.initials: HA
authors.lastname: DeVon
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000503:physiopathology*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors
keywords: Acute coronary syndrome; age; cardiovascular conditions; comorbidities; emergency medicine; symptoms