64 Assessment of high-sensitive troponin t monitoring in the emergency department for NSTE-ACS diagnosis: a clinical audit at manchester royal infirmary hospital

Abstract

Logistic regression was used to describe adjusted risk of mortality of older versus younger patients (adjusted for any history of heart failure, hypercholesterolemia, peripheral vascular disease, chronic obstructive pulmonary disease, ischaemic heart disease, presence of STEMI on presenting ECG, female sex, cardiogenic shock at presentation). Results 11,763 patients were diagnosed with ACS. 39% of patients were older (≥75 years); [Table 1]. Male 61%, female 39% in the older group and male 76%, female 24% in the younger group. Older patients had a greater comorbidity burden than younger patients [Table 1]. Percutaneous coronary intervention was performed in less older patients than younger patients (81.2% versus 86.2%, p<0.001). At discharge, older patients were prescribed less secondary-prevention medications than younger patients [Figure 1]. Median follow up was 4.8 years.Older patients were more likely to be readmitted to hospital with heart failure/recurrent MI post discharge than younger patients (22.7% versus 17.3%, p<0.001), but there was no difference in median readmission time (older 1.16 years; younger 1.33 years, p=0.33). When adjusted for baseline demographics and comorbidity, older patients had a greater risk of in-hospital mortality than younger patients (adjusted odds ratio (OR) 2.01, 95% confidence interval (CI) 1.54-2.61, p<0.001) [Table 2]. Older male patients had a greater risk of in-hospital death than younger males (adjusted OR 2.55, 95% CI 1.80-3.60, p<0.001). There was no difference in the risk of mortality for older patients compared with younger patients at one-year (adjusted hazard ratio (HR) 0.95, 95% CI 0.82-1.09, p=0.46) and at long-term follow up (HR 0.98, 95% CI 0.87-1.10, p=0.68). Conclusions Overall 39% of ACS patients were ≥75 years. This group of patients are more likely to die in-hospital and be readmitted following discharge, than younger patients. Older patients have a greater comorbidity burden than younger patients yet are discharged with less secondary prevention.