Abstract 3023: Symptom Differences Among Patients With and Without an Acute Coronary Syndrome Diagnosis
Background: In patients with acute coronary syndrome (ACS), prompt and accurate recognition of symptoms can lead to timely treatment. Clinicians treating patients with ACS also rely on symptoms for identifying high risk patients who may benefit from reperfusion therapies. Similar symptoms, however, may also occur with non-ACS diagnoses.
Objectives: In this study, common ACS symptoms are compared in patients presenting to the emergency department (ED) for presumed ACS and subsequently diagnosed with and without confirmed ACS.
Methods: Data were obtained from patients, with coronary artery disease, enrolled in a multi-site randomized clinical trial evaluating a nursing educational intervention aimed at reducing pre-hospital delay in patients at risk for ACS. During a two year follow-up period, data related to ED visits for symptoms suggestive of ACS were obtained from patients and medical record review.
Results: A total of 3522 patients were enrolled in the parent study and 565 (16%) presented to the ED for symptoms suggestive of ACS. Of the 565 patients, 331 (59%) had a confirmed ACS diagnosis, and 234 (41%) did not. The groups were similar with regard to demographic and clinical variables except for history of angina (75% ACS vs 67% no ACS, p=.041), percutaneous coronary intervention (PCI) (63% ACS vs 51% no ACS, p=.004), and diabetes (26% ACS vs 18% no ACS, p=.026). Differences in symptom presentation are summarized in the table⇓.
Conclusions: In a group of patients presenting to the ED for symptoms suggestive of ACS, those with confirmed ACS were more likely to have a history of angina, PCI, and diabetes. Chest pain and left arm pain were more common in the ACS group, whereas, shortness of breath was more common in the non-ACS group. Other commonly associated symptoms of ACS were similar between the groups.
Implications: Educational programs designed to reduce prehospital delay may benefit from including clinical factors and symptoms more likely to be associated with ACS.