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)
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2018, Heart and LungCitation Excerpt :In the current study, more women than men were found to present with atypical symptoms like dyspnea, nausea/vomiting, palpitations, epigastric pain, and backache. Three studies done in the west have shown similar findings i.e. women were found to experience atypical symptoms of ACS more commonly than men.24,25,26 Shin et al. conducted a meta-analysis of gender differences in ACS symptoms.21
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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.
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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.