Acute Coronary Syndromes in Older Adults: A Review of Literature

IntroductionAcute coronary syndromes (ACS) are the leading cause of death in older adults, aged 65 years or older. The clinical presentation varies, and the absence of chest pain may occur. Our purpose was to synthesize the published literature (2000–2012) to (1) examine the initial ED presentation of older adults with confirmed ACS, (2) identify knowledge gaps, (3) determine whether gender differences exist in the presentation of ACS, and (4) describe recommendations for practice and research.MethodsA systematic review was conducted from September 2000 to September 2012.ResultsThe review suggests that older adults with ACS report chest pain more commonly when arriving to the emergency department. Older adults have higher in-hospital mortality rates than adults aged younger than 65 years. However, older adults reporting an absence of chest pain on arrival are twice as likely to die compared with older adults with chest pain. With regard to gender differences, we note that men are more likely to present with chest pain whereas women are more likely to present with nausea. Women have higher in-hospital mortality rates both with and without chest pain presentation. Delay in time to arrival, as well as delay to primary percutaneous intervention, is reported for older adults with and without chest pain.DiscussionOlder adults with ACS are at risk for higher mortality rates and delays in time to treatment modalities. Early recognition of symptoms suggestive of ACS by the emergency triage nurse can improve patient outcomes.