Differences in mortality in acute coronary syndrome symptom clusters
Background: The timely and accurate identification of symptoms of acute coronary syndrome (ACS) is a challenge forpatients and clinicians. It is unknown whether response times and clinical outcomes differ with specific symptoms. We sought toidentify which ACS symptoms are related 'symptom clust...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Journal Article |
| Published: |
Elsevier
2010
|
| Online Access: | http://hdl.handle.net/20.500.11937/31253 |
| _version_ | 1848753326192066560 |
|---|---|
| author | Riegel, B. Hanlon, A. McKinley, S. Moser, D. Meischke, H. Doering, L. Davidson, Patricia Pelter, M. Dracup, K. |
| author_facet | Riegel, B. Hanlon, A. McKinley, S. Moser, D. Meischke, H. Doering, L. Davidson, Patricia Pelter, M. Dracup, K. |
| author_sort | Riegel, B. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background: The timely and accurate identification of symptoms of acute coronary syndrome (ACS) is a challenge forpatients and clinicians. It is unknown whether response times and clinical outcomes differ with specific symptoms. We sought toidentify which ACS symptoms are related 'symptom clusters' and to determine if sample characteristics, response times, and outcomes differ among symptom cluster groups. Methods: In a multisite randomized clinical trial, 3522 patients with known cardiovascular disease were followed up for 2 years. During follow-up, 331 (11%) had a confirmed ACS event. In this group, 8 presenting symptoms were analyzed using cluster analysis. Differences in symptom cluster group characteristics, delay times, and outcomes were examined. Results: The sample was predominately male (67%), older (mean 67.8, S.D. 11.6 years), and white (90%). Four symptom clusters were identified: Classic ACS characterized by chest pain; Pain Symptoms (neck, throat, jaw, back, shoulder, arm pain); Stress Symptoms (shortness of breath, sweating, nausea, indigestion, dread, anxiety); and Diffuse Symptoms, with a low frequency of most symptoms. Those in the Diffuse Symptoms cluster tended to be older (P = .08) and the Pain Symptoms group was most likely to have a history of angina (P = .01). After adjusting for differences, the Diffuse Symptoms cluster demonstrated higher mortality at 2 years (17%) than the other 3 clusters (2%-5%, P b .001), although prehospital delay time did not differ significantly. Conclusion: Most ACS symptoms occur in groups or clusters. Uncharacteristic symptom patterns may delay diagnosis and treatment by clinicians even when patients seek care rapidly. Knowledge of common symptom patterns may facilitate rapid identification of ACS. |
| first_indexed | 2025-11-14T08:22:44Z |
| format | Journal Article |
| id | curtin-20.500.11937-31253 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T08:22:44Z |
| publishDate | 2010 |
| publisher | Elsevier |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-312532018-03-29T09:09:00Z Differences in mortality in acute coronary syndrome symptom clusters Riegel, B. Hanlon, A. McKinley, S. Moser, D. Meischke, H. Doering, L. Davidson, Patricia Pelter, M. Dracup, K. Background: The timely and accurate identification of symptoms of acute coronary syndrome (ACS) is a challenge forpatients and clinicians. It is unknown whether response times and clinical outcomes differ with specific symptoms. We sought toidentify which ACS symptoms are related 'symptom clusters' and to determine if sample characteristics, response times, and outcomes differ among symptom cluster groups. Methods: In a multisite randomized clinical trial, 3522 patients with known cardiovascular disease were followed up for 2 years. During follow-up, 331 (11%) had a confirmed ACS event. In this group, 8 presenting symptoms were analyzed using cluster analysis. Differences in symptom cluster group characteristics, delay times, and outcomes were examined. Results: The sample was predominately male (67%), older (mean 67.8, S.D. 11.6 years), and white (90%). Four symptom clusters were identified: Classic ACS characterized by chest pain; Pain Symptoms (neck, throat, jaw, back, shoulder, arm pain); Stress Symptoms (shortness of breath, sweating, nausea, indigestion, dread, anxiety); and Diffuse Symptoms, with a low frequency of most symptoms. Those in the Diffuse Symptoms cluster tended to be older (P = .08) and the Pain Symptoms group was most likely to have a history of angina (P = .01). After adjusting for differences, the Diffuse Symptoms cluster demonstrated higher mortality at 2 years (17%) than the other 3 clusters (2%-5%, P b .001), although prehospital delay time did not differ significantly. Conclusion: Most ACS symptoms occur in groups or clusters. Uncharacteristic symptom patterns may delay diagnosis and treatment by clinicians even when patients seek care rapidly. Knowledge of common symptom patterns may facilitate rapid identification of ACS. 2010 Journal Article http://hdl.handle.net/20.500.11937/31253 10.1016/j.ahj.2010.01.003 Elsevier restricted |
| spellingShingle | Riegel, B. Hanlon, A. McKinley, S. Moser, D. Meischke, H. Doering, L. Davidson, Patricia Pelter, M. Dracup, K. Differences in mortality in acute coronary syndrome symptom clusters |
| title | Differences in mortality in acute coronary syndrome symptom clusters |
| title_full | Differences in mortality in acute coronary syndrome symptom clusters |
| title_fullStr | Differences in mortality in acute coronary syndrome symptom clusters |
| title_full_unstemmed | Differences in mortality in acute coronary syndrome symptom clusters |
| title_short | Differences in mortality in acute coronary syndrome symptom clusters |
| title_sort | differences in mortality in acute coronary syndrome symptom clusters |
| url | http://hdl.handle.net/20.500.11937/31253 |