Key result
Atypical symptoms in older adults show no link to reduced ACS diagnosis in the ED.
Why the study?
Atypical symptom presentations of ACS are common in older adults and may contribute to diagnostic delays or missed recognition in emergency departments, but national-level data examining this relationship are limited.
Are atypical chest pain presentations associated with a reduced likelihood of ACS diagnosis in older adults during ED visits?
Cross-Sectional (n=2,470)
Yes
Are atypical chest pain presentations associated with a reduced likelihood of ACS diagnosis in older adults during ED visits?
In older adults presenting to the ED, atypical symptoms were common among those diagnosed with ACS but were not significantly associated with a missed ACS diagnosis.
Supports maintaining ACS suspicion in older ED patients regardless of symptom type; hypothesis-generating and requires prospective validation.
Background Atypical symptom presentations of Acute Coronary Syndrome (ACS) are common in older adults and may contribute to diagnostic delays or missed recognition in emergency departments (EDs). National-level data examining this relationship remains limited. Objective To evaluate whether atypical chest pain presentations are associated with reduced likelihood of ACS diagnosis among U.S. adults aged 65 years and older during ED visits. Methods We conducted a retrospective cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2014 to 2020. ED visits by adults aged ≥65 years were analyzed. Atypical presentations were defined using Reason for Visit (RFV) codes for symptoms such as weakness, dyspnea, dizziness, nausea, syncope, and abdominal pain. The primary outcome was an ED diagnosis of ACS based on ICD-9-CM codes. Multivariable logistic regression was used to assess associations. Results Among 2,470 eligible ED visits, only 15 (0.6%) were diagnosed with ACS. Of those, 7 (46.7%) presented with atypical symptoms. Atypical presentation was not significantly associated with ACS diagnosis (OR: 0.90; 95% CI: 0.32-2.49; p = 0.83). No significant associations were found with age, sex, race/ethnicity, or ED disposition. The variable "admitted to hospital from ED" was excluded due to collinearity. Conclusion Nearly half of older adults diagnosed with ACS presented atypically, yet atypical presentation was not significantly associated with missed ACS diagnosis in the ED. Given the limitations of administrative data and low ACS event rates, future research using richer clinical datasets and follow-up outcomes is needed to better understand diagnostic gaps in this high-risk population.
No takes yet. Share an insight, caveat, or question.
Somo et al. (2025) conducted a cross-sectional in Acute Coronary Syndrome (n=2,470). Atypical symptom presentation vs. Typical symptom presentation was evaluated on Emergency department diagnosis of Acute Coronary Syndrome (ACS) (OR 0.90, 95% CI 0.32-2.49, p=0.83). Atypical symptom presentation in older adults was not significantly associated with a reduced likelihood of acute coronary syndrome diagnosis in the emergency department (OR 0.90).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: