Clinical outcome of older adults developing acute coronary syndrome during hospitalization for noncardiac illness: A prospective observational study

BACKGROUND: Atypical presentations of acute coronary syndrome (ACS) delay its recognition and treatment in older adults. Cognitive impairment, frailty, depression, and decline in functional status unique to older adults also influence the treatment and outcomes. The present study was conducted to identify noncardiac illnesses, leading to ACS in the hospitalized older adults and their outcomes. METHODS: Three hundred and ten older adults with ACS were included from June 26, 2020, to October 13, 2020. Subjects were divided into those admitted primarily due to an ACS (Group I, n = 94) and those developing ACS following hospitalization for noncardiac illness (Group II, n = 216). Comorbidities, medications, investigations, management, and clinical outcomes were compared between the two groups. RESULTS: Non-ST elevation ACS was more prevalent (90.2%) in Group II and the most common reason for hospitalization was acute kidney injury (27.1%). Optimum management was also given to a lesser extent to the subjects of Group II and they had the worst clinical outcome. CONCLUSION: Optimum management was not given to a considerable number of patients due to their current unstable clinical condition, adverse effects of drugs, and lack of specialty consultation during an ACS. Clinicians must be vigilant for the development of ACS when an older adult is admitted to the hospital, as early detection and optimum management would be life-saving.