Sex and Age Differences in Atypical Chief Complaints for Acute Decompensated Heart Failure in Emergency Department Visits

Regan, Matthew L.; Bischof, Jason J.; Bush, Montika; Waller, Anna E.; Platts-Mills, Timothy F.; Casey, Martin F.; Meyer, Michelle L.

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Original Article

doi: https://doi.org/10.15441/ceem.24.226 [Accepted]

Sex and Age Differences in Atypical Chief Complaints for Acute Decompensated Heart Failure in Emergency Department Visits

Matthew L. Regan¹

, Jason J. Bischof^1,2

, Montika Bush¹

, Anna E. Waller¹

, Timothy F. Platts-Mills³

, Martin F. Casey¹

, Michelle L. Meyer¹

¹University of North Carolina at Chapel Hill, 170 Manning Drive, Chapel Hill, NC, USA 27599-7594
²The Ohio State University, 370 W 9th Ave, Columbus, OH, USA, 43210
³Ophirex, Inc. Corte Madera, CA

Correspondence Michelle L. Meyer Tel: (919) 966-6539, Fax: (919) 966-3049, Email: michelle_meyer@med.unc.edu

Received: March 31, 2024. Revised: May 4, 2024. Accepted: May 6, 2024. Published online: May 23, 2024.

ABSTRACT

Objectives
Around one million United States emergency department (ED) visits annually are due to acute decompensated heart failure (ADHF) symptoms. Characterizing ED symptom presentation of ADHF patients may improve clinical care, yet sex and age differences in ED chief complaints have not been thoroughly investigated. This paper aims to describe differences in chief complaints and comorbid conditions for ED patients with a ADHF diagnosis, stratified by sex and age.
Methods
Retrospective analysis of adults presenting to North Carolina EDs in NC DETECT, a statewide syndromic surveillance system, between 2010 and 2016 with a diagnosis of ADHF. Frequencies of chief complaint categories for ED visits and comorbid conditions, stratified by sex and age, were evaluated and standardized differences computed.
Results
Top chief complaints were dyspnea (19.1%), chest pain (13.5%), and other respiratory complaints (13.4%). In the 18-44 age group, females when compared to males reported more nausea/vomiting (6.7% versus 4.1%) and headache (4.2% versus 2.0%). In those 45-64 and 65+ years old, complaints were similar by sex. When stratified by age group alone, the 18-44 and 45-64 age groups had more complaints of chest pain, whereas balance issues, weakness, and confusion were more common in the 65+ age group.
Conclusion
Sex and age differences in atypical ADHF symptoms were seen in in ED patients with ADHF. Characterizing variation of ADHF symptoms in ED patients can inform the identification of ED patients with ADHF and the management of ADHF-related symptoms.

Keywords: Emergency Department, Heart Failure Chief Complaints, Atypical Heart Failure Presentations, Heart Failure differences between age and sex