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Heart emergency room: effective for both geriatric and younger patients
F Lateef1, A B Storrow, B W Gibler
1Department of Emergency Medicine and Center for Emergency Care, University of Cincinnati College of Medicine, Ohio, USA. gaefal@sgh.gov.sg
Insights
This study found no significant difference in 30-day cardiac events between geriatric and younger patients managed in an emergency department chest pain center. The protocol effectively risk-stratified both groups for acute coronary events.
Area of Science:
- Cardiology
- Emergency Medicine
- Geriatric Medicine
Background:
- Chest pain is a common emergency department (ED) presentation.
- Risk stratification is crucial for managing patients with chest pain.
- Geriatric patients may have different cardiac event rates compared to younger individuals.
Purpose of the Study:
- To compare the 30-day cardiac event rate in patients aged 60 years and older versus those younger than 60.
- To evaluate the effectiveness of an ED-based chest pain center protocol for risk stratification and management.
Main Methods:
- Retrospective cohort study of 2491 patients presenting with non-traumatic chest pain.
- Inclusion of patients aged 25 years and older, excluding those with ST-elevation/depression, hemodynamic instability, or unstable angina.
- Utilized continuous ECG monitoring, serial CK-MB draws, graded exercise stress tests, or sestamibi scans within a 6- or 9-hour protocol.
Main Results:
- No statistically significant differences in 30-day cardiac events between geriatric (n=304) and younger patients.
- Prevalence of risk factors, positive GXT for ischemia, admission rates, and CCU admissions were similar between groups.
- Geriatric patients had a 3.6% 30-day complication rate versus 2.4% in younger patients (p=0.303).
Conclusions:
- ED-based chest pain units are effective for risk-stratifying and managing both geriatric and young patients.
- The protocol demonstrated similar safety and efficacy across age groups for low-to-moderate risk acute coronary events.
Objectives:
To compare the 30-day cardiac event rate between patients aged at least 60 years (geriatric group) with those younger than 60 (younger group), who were enrolled in an Emergency department-based chest pain centre management protocol.
Methodology:
This was a retrospective, cohort study done at the Centre for Emergency Care at the University of Cincinnati, from 1 Oct 1991 to 31 March 1999 (from Oct 1991 to Dec 1998: 9-hour protocol in use; from Jan 1999 to March 1999: 6-hour protocol in use). Patients, at least 25 years, with the chief complaint of non-traumatic chest pain were eligible for management in the unit. Exclusion criteria included acute ST-elevation or depression > 1 mm in 2 contiguous leads, haemodynamic instability or clinical syndrome consistent with unstable angina. Outcomes studied were disposition and cardiac events at 30-days (defined as acute myocardial infarction, congestive heart failure, ventricular fibrillation / tachycardia arrest, coronary artery bypass surgery or percutaneous transluminal coronary angioplasty). The protocol was the standard of care and enrolled patients underwent continuous ECG and ST-segment trend monitoring, serial CK-MB draws at 0, 3, 6 and 9 hours, followed by either a graded exercise stress test or a sestamibi myocardial perfusion scan (from Oct 1998). With the 6-hour protocol the 9-hour draws were omitted and the GXTdone 3 hours earlier.
Results:
A total of 2491 patients were enrolled; 304 (12.2%) in the geriatric age-group. The mean age was 66.8+/-5.9 and 41.3+/-8.6 years respectively. There were 133 (43.8%) female patients in the geriatric group and 1170 (53.5%) in the younger group. There were no statistically significant differences between the groups in terms of prevalence of risk factors, but there was significant (p < 0.001) and ECG changes from the baseline (p = 0.0015). The geriatric patients were also not different from the younger ones in terms of GXT positive for ischaemia (10, 5.3% vs 42, 2.7%; p = 0.124), admission rates (61, 20.1% vs 321, 14.7%; p = 0.312), coronary care unit admissions (8, 2.6% vs 63, 2.9%; p = 0.418 and 30-day complication rate (10, 3.6% vs 46, 2.4%; p = 0.303).
Conclusion:
The ED-based chest pain unit represents an effective way for the risk-stratification and management of both geriatric and young patients with low-to-moderate risk of acute coronary events.