Symptom Clusters in Patients Who Ruled Out for Acute Coronary Syndrome: Age Matters

Thursday, 25 July 2013: 3:35 PM

Holli A. DeVon, PhD, RN, FAHA
College of Nursing, University of Illinois at Chicago, Chicago, IL
Anne G. Rosenfeld, PhD, RN, FAAN, FAHA
College of Nursing, University of Arizona, Tucson, AZ

Learning Objective 1: The learner will identify symptom clusters in patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome but subsequently ruled out.

Learning Objective 2: The learner will explain the significance of age in patients presenting with symptoms suggestive of acute coronary syndrome.

Purpose: Patients with potential acute coronary syndrome (ACS) make a decision to present to the emergency department (ED) partially based on symptoms. Differentiating which patients have ACS and require cardiac evaluation presents a diagnostic conundrum. Empirically derived symptom profiles could assist in risk stratification. Therefore, the purpose of the study was to examine the influence of age on subgroups of patients with similar symptom clusters who presented to the ED with symptoms suggestive of ACS who subsequently ruled out.

Methods: A sample of 318 patients (148 women; 170 men) was recruited from 3 EDs in 3 US states. Symptom data were collected upon presentation using a reliable and valid 13-item symptom checklist. Latent class analysis was used to identify patient groups (latent classes) with similar symptom profiles. Analysis of Variance (ANOVA) was used to compare symptoms by age.

Results: Mean age was 57.6 (±15.6) years. The most frequently reported symptom was chest discomfort (69.4%). Analysis of symptoms resulted in a 3 class solution. Class 1 (n = 114) included 7 high probability symptoms including chest pressure, chest discomfort, shortness of breath, unusual fatigue, nausea, lightheadedness, and chest pain. Class 2 (n = 102) included 3 high probability symptoms, all in the chest including pressure, discomfort, and pain. Class 3 (n = 102) included 3 moderate probability symptoms; shortness of breath, unusual fatigue, and lightheadedness. Patients in class 3 were significantly older: 63.6 years vs. 54 years (class 1) and 55.7 years (class 2) (p<0.0167).

Conclusion: Patients who present to the ED with ACS-like symptoms and are ruled-out can be classified into symptom clusters which vary by age. Older patients may be vulnerable to poorer outcomes due to ambiguous symptom clusters. Further research is required to determine clinical implications.