The forthcoming wave of geriatric patients is expected to result in rising incidence of myocardial infarction (MI), made uniquely challenging by atypical symptoms, multiple comorbidities, and cognitive impairment. Hence, misdiagnosis, undertreatment, and poor outcome are common.
In this cross‐sectional study, we reviewed the records of 6 hospitals over a 1‐year period on 558 patients aged 65 and above whose primary discharge diagnosis was MI. Impact of age, sex, race, nursing home residency, diabetes mellitus, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and dementia on symptom presentation and in‐hospital outcome of MI were studied using chi‐square, relative risk, and logistic regression analyses.
Three hundred and twenty‐one patients (58%) had non‐chest pain symptoms. Patients aged 90 and above were more likely to have atypical symptoms, with the most significant difference seen in comparison with those aged 65‐69 (RR = 1.39, P = .001). Female patients (RR = 1.23, P = .005), nursing home residents (RR = 1.51, P = .001), and those with COPD (RR = 1.25, P = .007), CHF (RR = 1.53, P = .000), or dementia (RR = 1.62, P = .001) were also more likely to present atypically. Patients with no chest pain were twice less likely to receive invasive treatment (RR = 1.98, P = .001) and twice as likely to survive during admission (RR = 2.00, P = .001).
Our results suggest that advanced age, female sex, nursing home residence, COPD, CHF, and dementia are independent predictors of atypical MI presentation among the elderly. Notably, the association of nursing home residence and dementia with MI in the elderly has not been investigated before to our knowledge. Understanding the factors that influence MI presentation may improve recognition, diagnosis, and management of this complex group of patients.
S. R. Krim, None; R. P. Vivo, None; I. Ghobrial, None.
To cite this abstract:Krim S, Vivo R, Ghobrial I. Impact of Sex, Race, Nursing Home Residence, and Coexisting Diseases on Presentation and Outcome of Myocardial Infarction in the Elderly. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 36. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/impact-of-sex-race-nursing-home-residence-and-coexisting-diseases-on-presentation-and-outcome-of-myocardial-infarction-in-the-elderly/. Accessed April 25, 2019.