Regular paperAtypical presentations among medicare beneficiaries with unstable angina pectoris*☆,
Section snippets
Patient selection:
We examined the medical records of 4,167 Medicare patients enrolled in the Alabama Unstable Angina Study with a confirmed diagnosis of UAP. These patients were hospitalized at 22 centers throughout the state of Alabama between January 1, 1993, and December 31, 1999. Patients receiving treatment at hospitals participating in this study were identified from Medicare Part A Standard Analytic (MEDPAR) files. We developed a stratified random sampling method based upon the following the International
Baseline and presenting characteristics:
Table 1 summarizes baseline and presenting characteristics of the typical and atypical UAP groups. Over half of patients with confirmed UAP in this study had atypical presentations. A slightly higher proportion of UAP women with atypical symptoms were older, but no important differences were found by ethnicity. Also, UAP patients with atypical presentations were less likely to have a history of MI, hypercholesterolemia, or family history of heart disease, but were more likely to have a history
Discussion
This analysis represents one of the largest in-depth studies to examine the presenting symptoms of patients hospitalized with UAP. Among Medicare patients with confirmed UAP, we found that over half had atypical presentations, and the predominant symptoms were shortness of breath, nausea, diaphoresis, and pain or discomfort localized to other areas of the body such as the arm, epigastrium, shoulder, neck, or jaw. Also, 1 in 7 of the patients with atypical presentations of UAP had atypical chest
References (20)
- et al.
International diagnostic criteria for acute myocardial infarction and acute stroke
Am Heart J
(1984) - et al.
Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room
Am J Cardiol
(1987) - et al.
Missed diagnosis of acute myocardial infarction in the emergency departmentresults from a multicenter study
Ann Emerg Med
(1993) - et al.
A chest pain clinic to improve the follow-up of patients released from an urban university teaching hospital emergency department
Ann Emerg Med
(1987) - et al.
The art and science of chart review
Joint Commission J Qual Improve
(2000) Atypical chest pain
Emerg Med Clin North Am
(1998)- et al.
Patterns of coronary heart disease morbidities and mortality in the sexesa 26-year follow-up of the Framingham population
Am Heart J
(1986) - et al.
Do gender-based differences in presentation and management influence predictors of hospitalization costs and length of stay after an acute myocardial infarction?
Am J Cardiol
(1995) - et al.
Lack of pain during myocardial infarction in diabetics—is autonomic dysfunction responsible?
Am J Cardiol
(1991)
Cited by (111)
Non-ST-Elevation Acute Coronary Syndromes
2022, Practical Cardiology: Principles and ApproachesHigh-Risk Chief Complaints I: Chest Pain—The Big Three (an Update)
2020, Emergency Medicine Clinics of North AmericaCitation Excerpt :When the Framingham researchers discovered that 25% of the MIs in their cohort of patients had been diagnosed by routine office electrocardiograms (ECGs) after the actual event had long been completed, they postulated that these MIs were missed as a result of being “silent” or atypical.19 Inconsistent methods of defining atypical presentations, however, have resulted in widely varying estimates of their incidence, ranging from 6% to 52%.20–26 Nevertheless, these studies have identified several populations that are consistently more likely to present in an atypical fashion: women, the elderly, and nonwhite minorities.4,20,27
Comparison of Outcomes in Patients With Acute Coronary Syndrome Presenting With Typical Versus Atypical Symptoms
2019, American Journal of Cardiology
- ☆
This work was supported by Grant HS08843 from the Agency for HealthCare Research and Quality and conducted in cooperation with the Alabama Quality Assurance Foundation and the Centers for Medicare and Medicaid Services, Birmingham, Alabama.
- *
This material was prepared by the Alabama Quality Assurance Foundation under a contract with the Centers for Medicare and Medicaid Services (CMS). Contents do not necessarily represent CMS policy.