Abstract 16626: Age-related Differences in Presentation and Assessed Risk of Suspected Coronary Artery Disease in the Clinic: Insights From the PROMISE Trial
Background: Coronary artery disease (CAD) prevalence increases with age, yet the clinical presentation and risk assessment associated with suspected CAD in the elderly in the contemporary era are unknown.
Methods: Characteristics, clinical presentation and risk assessment for the 10,003 stable suspected CAD patients in the PROMISE trial were compared by age group.
Results: Of the 29% of patients who were aged ≥65 years (n=2892), 2286 (79%) were 65-74 years and 606 (21%) were ≥75 years. Compared to younger patients, those aged ≥75 years differed in demographics, risk factors and primary symptoms. Although chest pain was still the most frequent presenting symptom, dyspnea was a more common primary presentation in older patients (Table). Of note, history of heart failure was rare, and presenting chest pain was similarly described as tightness in most regardless of age (p=0.390). Physicians assessed a third of those aged ≥75 years as having low pretest likelihood of CAD compared to <10% who were assigned a low pretest likelihood by a risk score algorithm (Diamond-Forrester). Generalized logistic regression models, adjusted for presentation and risk factors, showed that the odds of being classified as high vs. low likelihood of CAD increased with age, although to a greater degree by risk algorithm (OR 1.80/10 year older age, 95% CI 1.62-1.99; p<0.001) than by physician assessment (OR 1.28, 95% CI 1.14-1.43; p<0.001).
Conclusions: Older patients with suspected CAD differ from younger patients in risk profiles, presentation and assessed risk of significant CAD by physicians compared to scoring algorithms. Lower estimation of likelihood of significant CAD may be the result of differences in presenting symptoms in older patients.
Author Disclosures: K.P. Alexander: Research Grant; Significant; Gilead Sciences, Sanofi Aventis, Regeneron Pharmaceuticals. Consultant/Advisory Board; Significant; CytRx Corp.. P.A. Pellikka: None. A. Coles: None. N.J. Pagidipati: None. M. Gharacholou: None. R. Mehta: Research Grant; Significant; Amgen, AstraZeneca, Bristol-Myers Squibb. S.E. Litwin: None. K.L. Lee: None. D.B. Mark: Research Grant; Significant; Eli Lilly, Bristol-Myers Squibb, Gilead Sciences, AGA Medical, Merck, Oxygen Biotherapeutics, AstraZeneca. Consultant/Advisory Board; Modest; Medtronic, CardioDx, St. Jude Medical. L. Cooper: None. R.P. Bullock-Palmer: None. U. Hoffmann: Research Grant; Significant; HeartFlow, Siemens Healthcare. P.S. Douglas: Research Grant; Significant; General Electric, HeartFlow.
- © 2016 by American Heart Association, Inc.