ArticleCureus2025
Retrospective Analysis of Atypical Chest Pain Presentations in Older Adults and Their Association With Missed Acute Coronary Syndrome Diagnosis in the Emergency Department: National Hospital Ambulatory Medical Care Survey (NHAMCS)-Based Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Article
- The Irreversible March of Time: Ischemic Delay and Impact on Outcomes in ST-Segment Elevation Myocardial Infarction.Journal of cardiovascular development and disease · 2025Review
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background Atypical symptom presentations of Acute Coronary Syndrome (ACS) are common in older adults and may contribute to diagnostic delays or missed recognition in emergency departments (EDs). National-level data examining this relationship remains limited. Objective To evaluate whether atypical chest pain presentations are associated with reduced likelihood of ACS diagnosis among U.S. adults aged 65 years and older during ED visits. Methods We conducted a retrospective cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2014 to 2020. ED visits by adults aged ≥65 years were analyzed. Atypical presentations were defined using Reason for Visit (RFV) codes for symptoms such as weakness, dyspnea, dizziness, nausea, syncope, and abdominal pain. The primary outcome was an ED diagnosis of ACS based on ICD-9-CM codes. Multivariable logistic regression was used to assess associations. Results Among 2,470 eligible ED visits, only 15 (0.6%) were diagnosed with ACS. Of those, 7 (46.7%) presented with atypical symptoms. Atypical presentation was not significantly associated with ACS diagnosis (OR: 0.90; 95% CI: 0.32-2.49; p = 0.83). No significant associations were found with age, sex, race/ethnicity, or ED disposition. The variable "admitted to hospital from ED" was excluded due to collinearity. Conclusion Nearly half of older adults diagnosed with ACS presented atypically, yet atypical presentation was not significantly associated with missed ACS diagnosis in the ED. Given the limitations of administrative data and low ACS event rates, future research using richer clinical datasets and follow-up outcomes is needed to better understand diagnostic gaps in this high-risk population.
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Registered trials
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