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

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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.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. Alexander Fardman and Moran Livne both authors contributed equally to the writing of the manuscript.

Authors and Affiliations

  1. Cardiovascular Division, Intensive Cardiac Care Unit, The Leviev Heart Center, Sheba Medical Center, 52621, Tel Hashomer, Israel

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

  2. The Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel

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

Authors
  1. Alexander Fardman
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  2. Moran Livne
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  3. Ronen Goldkorn
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  4. Orly Goitein
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  5. Nir Shlomo
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  8. Michael Naroditsky
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  9. Shlomi Matetzky
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  10. Roy Beigel
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Contributions

Conceptualization: AF, SM, RB. Methodology: NS, OG, EA, MN. Formal analysis and investigation: AG, MN, SM. Writing—original draft preparation: AF, ML, EA, RB. Writing—review and editing: AF, ML, OG, SM. Supervision: NS, SM, RB.

Corresponding author

Correspondence to Roy Beigel.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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The Sheba Medical Center institutional review board approved the study and the informed consent process.

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Fardman, A., Livne, M., Goldkorn, R. et al. The efficacy and safety of evaluating elderly patients using a comprehensive diagnostic protocol via a chest pain unit. Intern Emerg Med 15, 1061–1066 (2020). https://doi.org/10.1007/s11739-020-02289-0

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