Symptom Differences in Older and Younger Women With Suspected Heart Disease

Purpose: To determine if older (≥65y) and younger (<65y) women presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) varied on risk factors, comorbid conditions, and symptoms which have implications for personalized care. Many young women are unaware of their risk for heart disease. Younger women also have increasing rates of comorbid conditions and more symptoms during myocardial infarction (MI). Older women have more risk factors and the average age at MI is 71.8 years.

Methods: Patients admitted to five EDs for evaluation of ACS were enrolled. The 13-item validated ACS Symptom Checklist was administered to measure symptoms on presentation. Comorbid conditions and functional status were measured with the Charlson Comorbidity Index and the Duke Activity Status Index. Logistic regression was used to evaluate symptom differences in older and younger women adjusting for ACS diagnosis, functional status, body mass index (BMI), diabetes and other comorbid conditions.

Results: The mean age of the convenience sample of 394 women was 61.4 years (range 21-98 years). Younger women (n=232) were more likely to be Black (p=0.042), college educated (p=0.028), and to have a non-ACS discharge diagnosis (p=0.048). Older women (n =162) were more likely to be White, have hypertension (<0.001), hypercholesterolemia (p=0.003), a higher BMI (p=0.001), more comorbid conditions (p<0.001), lower functional status (p<0.001), never have smoked (p<0.001), and be diagnosed with non-ST elevation MI (p=0.048). Younger women had higher odds of experiencing chest discomfort (OR=2.78, CI, 1.65-4.67), chest pain (OR=1.78, CI, 1.09-2.89), chest pressure (OR=2.57, CI, 1.55-4.24), shortness of breath, (OR=2.22, CI, 1.35-3.64), nausea (OR=1.64, CI, 1.01-2.64), sweating (OR=1.93, CI, 1.17-3.19), and palpitations (OR=1.87, CI, 1.12-3.14).

Conclusion: Lack of chest discomfort, chest pain, chest pressure, and shortness of breath, key symptoms triggering a decision to seek emergent care, may influence older women to delay treatment, placing them at risk for poorer outcomes. Younger Black women require more comprehensive risk reduction strategies and symptom management. Risk reduction and symptom management strategies should be personalized by race and age in women evaluated for ACS.