Clinical cardiology · 2026
Age Differences in Acute Chest Pain Care in a Multisite US Cohort.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Ashburn Nicklaus P, Snavely Anna C, Paukner Lyle, Supples Michael W, Hutchison Benjamin T, Pearson David A, Mahler Simon A
Аннотация
BACKGROUND: This study aims to determine if differences in age affect safety and healthcare utilization among patients with chest pain in a multisite US ED cohort, after accounting for comorbidities and high-sensitivity troponin (hs-cTn).
METHODS: We conducted a multisite observational study using the Wake Forest Chest Pain Registry, which included patients ≥ 18 years old with chest pain across 25 EDs (01/01/2021 to 12/31/2021). Each site used an hs-cTn chest pain protocol. Patients were categorized as older (≥ 65 years), middle-aged (46-64 years), or young (18-45 years). The primary safety outcome was death or MI at 30 days. The primary healthcare utilization outcome was 30-day hospitalization. Multivariable logistic regression models assessed the association between age and outcomes, adjusting for sex, race, ethnicity, obesity, smoking, rurality, coronary disease, diabetes, hypertension, hyperlipidemia, insurance, site, and hs-cTn, with young patients as the reference.
RESULTS: Among 40 979 patients, 25.1% were older, 39.7% middle-aged, and 35.2% young. At 30 days, death or MI occurred in 7.3% (750/10 298) of older, 3.8% (611/16 260) of middle-aged, and 0.8% (108/14 421) of young patients. After adjustment, death or MI at 30 days was more common among older (aOR 1.57, 95% CI 1.17-2.12) and middle-aged (aOR 1.57, 95% CI 1.22-2.02) patients. Hospitalization at 30 days occurred in 56.3% (5799/10 298) of older, 35.4% (5761/16 260) of middle-aged, and 12.8% (1849/14 421) of young patients. With adjustment, hospitalization remained more common among older (aOR 2.51, 95% CI 2.27-2.78) and middle-aged (aOR 1.93, 95% CI 1.80-2.07) patients.
CONCLUSION: After adjusting for comorbidities and hs-cTn results, older adults had higher rates of death or MI and hospitalization at 30 days.
METHODS: We conducted a multisite observational study using the Wake Forest Chest Pain Registry, which included patients ≥ 18 years old with chest pain across 25 EDs (01/01/2021 to 12/31/2021). Each site used an hs-cTn chest pain protocol. Patients were categorized as older (≥ 65 years), middle-aged (46-64 years), or young (18-45 years). The primary safety outcome was death or MI at 30 days. The primary healthcare utilization outcome was 30-day hospitalization. Multivariable logistic regression models assessed the association between age and outcomes, adjusting for sex, race, ethnicity, obesity, smoking, rurality, coronary disease, diabetes, hypertension, hyperlipidemia, insurance, site, and hs-cTn, with young patients as the reference.
RESULTS: Among 40 979 patients, 25.1% were older, 39.7% middle-aged, and 35.2% young. At 30 days, death or MI occurred in 7.3% (750/10 298) of older, 3.8% (611/16 260) of middle-aged, and 0.8% (108/14 421) of young patients. After adjustment, death or MI at 30 days was more common among older (aOR 1.57, 95% CI 1.17-2.12) and middle-aged (aOR 1.57, 95% CI 1.22-2.02) patients. Hospitalization at 30 days occurred in 56.3% (5799/10 298) of older, 35.4% (5761/16 260) of middle-aged, and 12.8% (1849/14 421) of young patients. With adjustment, hospitalization remained more common among older (aOR 2.51, 95% CI 2.27-2.78) and middle-aged (aOR 1.93, 95% CI 1.80-2.07) patients.
CONCLUSION: After adjusting for comorbidities and hs-cTn results, older adults had higher rates of death or MI and hospitalization at 30 days.