The efficacy and safety of evaluating elderly patients using a comprehensive diagnostic protocol via a chest pain unit

Alexander Fardman, Moran Livne, Ronen Goldkorn, Orly Goitein, Nir Shlomo, Elad Asher, Avishay Grupper, Michael Naroditsky, Shlomi Matetzky, Roy Beigel

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Elderly patients are often excluded from a chest pain unit (CPU)-based evaluation of chest pain due to concern about adverse events and poorer outcomes. The aim of this study was to assess the feasibility and safety of thoroughly evaluating elderly patients ≥ 65 years of age presented with acute chest pain via a CPU. We evaluated 1220 consecutive patients admitted to our CPU, and stratified them according to age: those over and those under 65 years. Patients were evaluated for outcomes during hospitalization and for a composite endpoint at 60 days post discharge which included: recurrent hospitalization due to chest pain, need for coronary revascularization, acute coronary syndrome, and death. Overall, 241 (20%) patients were in the ≥ 65-year-old group and 979 (80%) patients in the group < 65 years of age. Older patients were more likely to be female, have more co-morbidities, and a history of prior coronary artery disease. There was no difference between the two groups regarding in-hospital course, including hospitalization in the CPU (9.5% vs. 11.6%, p = 0.37), coronary angiography (7.9% vs. 9.8%, p = 0.37), and revascularization performed during the evaluation period (4.5% vs. 3.3%, p = 0.42). Of those discharged, the primary endpoint at 60 days was observed in 11 (1.5%) and 7 (3.9%) patients in those under and over 65 years, respectively, (p = 0.13). No mortalities were recorded. Comprehensive evaluation via a CPU of patients who are ≥ 65 years of age is feasible and safe with in-hospital and short-term outcomes compared to their younger counterparts.

    Original languageEnglish
    Pages (from-to)1061-1066
    Number of pages6
    JournalInternal and Emergency Medicine
    Volume15
    Issue number6
    DOIs
    StatePublished - 1 Sep 2020

    Keywords

    • Acute coronary syndrome
    • Chest pain
    • Chest pain unit
    • Elderly

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