Gap care in diagnostic and prognostic evaluation of chest pain in the elderly

Introduction

Despite the greater prevalence of coronary disease, aortic pathology and pulmonary thrombolysis in elderly patients, some studies have shown under-utilization of diagnostic and therapeutic resources in this age group.

Methods

A total of 541 patients (220 [46%] female) attended the Hospital Pró-Cardíaco Chest Pain Center, Rio de Janeiro, Brazil, from January to December 2004. The patients were divided into four age groups: I: <65 years, n = 264 (48.7%); II: between 65 and 74 years, n = 131 (24.2%); III: between 75 and 84 years, n = 104 (19.2%); and IV: >85 years, n = 42 (7.7%).

Diagnostic and/or risk stratification tests (treadmill stress test, myocardial scintigraphy, pulmonary scintigraphy, stress echocardiogram, angio-tomography, angio-magnetic resonance, transesophageal echocardiography, coronariography) were analyzed and patients were divided into two groups: DIAG (patients with at least one test done) and NO DIAG (patients without any test done). The intrahospital mortality (MORT) rate was also analyzed and compared between the age groups.

Results

Table 1 shows the diagnostic test evaluation and the intrahospital mortality rate according to age group.

Table 1

Conclusion

Elderly patients, especially the 'oldest old', that come to the emergency room with chest pain have a greater likelihood of discharge without any diagnostic and/risk stratification test being performed, compared with younger patients. The intrahospital mortality rate increased with age. These findings show a gap in care of the elderly with chest pain, which in turn may be associated with a worse prognosis in that population.