Impact of comorbidities by age on symptom presentation for suspected acute coronary syndromes in the emergency department.
Impact of comorbidities by age on symptom presentation for suspected acute coronary syndromes in the emergency department.
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DOI：
10.1177/1474515117693891
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发表时间：
2017-08
影响因子：
2.9
通讯作者：
DeVon HA
中科院分区：
文献类型：
--
作者：
Burke LA;Rosenfeld AG;Daya MR;Vuckovic KM;Zegre-Hemsey JK;Felix Diaz M;Tosta Daiube Santos J;Mirzaei S;DeVon HA
据估计，一半的急性冠脉综合征(ACS)患者有一种或多种相关的并存情况。目的是：1)检查出现急性冠脉综合征症状的急诊科患者的并存情况的患病率；2)确定并存情况是否影响急性冠脉综合征的症状；以及3)确定并存情况是否预测接受急性冠脉综合征诊断的可能性。在这项前瞻性研究中，共有1064名患者在五个急诊科住院。在向急诊科提交报告时对症状进行测量。Charlson共病指数(CCI)用于评估人群在人口统计特征、危险因素、临床表现和诊断方面的共病负担差异。最突出的合并症是既往的心肌梗死、无靶器官损害的糖尿病和慢性肺部疾病。在较年轻的急性冠脉综合征患者中，较高的CCI预示较少的胸痛、胸部不适、异常疲劳和较少的症状。在老年急性冠脉综合征患者中，较高的CCI预示着更多的胸部不适、上背部疼痛、突然症状出现和更大的症状苦恼。对于年轻的非急性冠脉综合征患者，CCI越高，胸痛和症状痛苦越少。较高的CCI与较年轻但年龄较大的疑似急性冠脉综合征患者接受急性冠脉综合征诊断的可能性较大相关。较年轻的急性冠脉综合征患者和较多的合并症患者报告较少的胸痛，这使得他们面临更高的延迟诊断和治疗的风险，因为胸痛是急性冠脉综合征的标志症状。
It is estimated half of acute coronary syndrome (ACS) patients have one or more associated comorbid conditions. Aims were to: 1) examine the prevalence of comorbid conditions in patients presenting to the emergency department with symptoms suggestive of ACS; 2) determine if comorbid conditions influence ACS symptoms; and 3) determine if comorbid conditions predict the likelihood of receiving an ACS diagnosis. A total of 1064 patients admitted to five emergency departments were enrolled in this prospective study. Symptoms were measured on presentation to the emergency department. The Charlson Comorbidity Index (CCI) was used to evaluate group differences in comorbidity burden across demographic traits, risk factors, clinical presentation, and diagnosis. The most prominent comorbid conditions were prior myocardial infarction, diabetes without target organ damage, and chronic lung disease. In younger ACS patients, higher CCI predicted less chest pain, chest discomfort, unusual fatigue and a lower number of symptoms. In older ACS patients, higher CCI predicted more chest discomfort, upper back pain, abrupt symptom onset, and greater symptom distress. For younger non-ACS patients, higher CCI predicted less chest pain and symptom distress. Higher CCI was associated with a greater likelihood of receiving an ACS diagnosis for younger but not older patients with suspected ACS. Younger patients with ACS and higher number of comorbidities report less chest pain, putting them at higher risk for delayed diagnosis and treatment since chest pain is a hallmark symptom for ACS.
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影响因子：
8.3
作者：
Goldstein, LB;Samsa, GP;Horner, RD
通讯作者：
Horner, RD
影响因子：
2.5
作者：
DeVon, HA;Zerwic, JJ
通讯作者：
Zerwic, JJ
影响因子：
2
作者：
DeVon, Holli A.;Burke, Larisa A.;Rosenfeld, Anne G.
通讯作者：
Rosenfeld, Anne G.
影响因子：
5.7
作者：
Radovanovic, Dragana;Seifert, Burkhardt;Erne, Paul
通讯作者：
Erne, Paul
DOI：
10.1111/j.1532-5415.2011.03391.x
发表时间：
2011-05-01
影响因子：
6.3
作者：
Boyd, Cynthia M.;Leff, Bruce;Weiss, Carlos O.
通讯作者：
Weiss, Carlos O.