More than 1.4 million Americans are expected to experience an episode of acute coronary syndromes (ACS) in 2010. Evaluation of the symptoms of ACS is important since symptoms determine when, or if, patients seek care. Recent studies have identified gender differences in symptoms of ACS, however retrospective designs, abstraction of symptoms from medical records, and variations in assessment forms make it difficult to determine the clinical significance of gender differences or if gender specific health messages are warranted. Therefore, the aims of this prospective study are to: 1) evaluate for gender differences in the occurrence, severity, and distress of 13 ACS symptoms after adjusting for age, diagnosis, comorbidities, and functional status, 2) establish the sensitivity, specificity, and predictive value of symptoms as an indicator of ACS for women and men, 3) explore symptom clusters including characteristics of gender, age, diagnosis, comorbidities, and functional status, and 4) determine if there are gender differences in the longitudinal (30 days and 6 months) outcomes of functional status, major cardiovascular events, hospital admissions, emergency department visits, and mortality. An exploratory aim is to determine if a relationship exists between selected biomarkers and symptoms of ACS for women and men. A novel approach, in which symptoms are recorded in the emergency department as they are occurring, will be used. The sample will be comprised of 630 patients admitted to the emergency department with symptoms suggestive of ACS: 522 patients with confirmed ACS and 108 patients ruled out for ACS. Participants will be recruited from four medical centers in Illinois and Oregon. The 13-item ACS Symptom Checklist will be completed on presentation to the emergency department. Comorbidities, activity status, and patient variables will be measured when the patient is stable. Pilot data indicate that the procedures are feasible and safe. Analysis of covariance will be used to test the hypothesis that there are gender differences in symptoms. Symptom clusters will be examined using agglomerative cluster analysis, and patient outcomes will be evaluated using linear mixed methods. Findings will aid in establishing the clinical significance of ACS symptoms.

Public Health Relevance

This study will address limitations of prior research including lack of prospective designs, systematic methods, standardized assessment forms, and evaluation of sensitivity and specificity of symptoms, particularly important since symptoms trigger health seeking behaviors. Given persistently long patient decision-delay, comprehensive evaluation of symptoms for a potential life-threatening illness take on added urgency.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
3R01NR012012-05S1
Application #
8660751
Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
Huss, Karen
Project Start
2010-09-28
Project End
2014-06-30
Budget Start
2013-08-09
Budget End
2014-06-30
Support Year
5
Fiscal Year
2013
Total Cost
$99,861
Indirect Cost
$34,227
Name
University of Illinois at Chicago
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
098987217
City
Chicago
State
IL
Country
United States
Zip Code
60612
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DeVon, Holli A; Burke, Larisa A; Nelson, Heather et al. (2014) Disparities in patients presenting to the emergency department with potential acute coronary syndrome: it matters if you are Black or White. Heart Lung 43:270-7
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DeVon, Holli A; Rosenfeld, Anne; Daya, Mohamud (2013) Cardiac symptoms in women and men. JAMA Intern Med 173:1927-8