Age Differences in the Chief Complaint Associated with a First Acute Myocardial Infarction and Patient's Care Seeking Behavior

UMMS Affiliation

Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine; Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Cardiology | Cardiovascular Diseases | Epidemiology | Health Services Administration | Health Services Research


BACKGROUND: To describe age differences in patient's chief complaint related to a first myocardial infarction, and how the "typicality" of patient's acute symptoms relates to extent of pre-hospital delay.

METHODS: The medical records of 2,586 central Massachusetts residents hospitalized at 11 greater Worcester medical centers with a first myocardial infarction on a biennial basis between 2001 and 2011 were reviewed.

RESULTS: The average age of the study population was 66.4 years, 39.6% were women, 40.2% were diagnosed with a STEMI, and 72.0 % presented with typical symptoms of myocardial infarction, namely acute chest pain/pressure. Patients were categorized into five age strata: those less than 55 years old (23%), 55-64 years (20%), 65-74 years (19%), 75-84 years (22%), and those 85 years and older (16%). The lowest proportion (11%) of atypical symptoms of myocardial infarction was observed in patients < 55 years, increasing to 17%, 28%, 40%, and 51% across our respective age groups. The most prevalent chief complaint reported at the time of hospitalization was chest pain but the proportion of patients reporting this symptom decreased from the youngest (83%) to the oldest patient groups (45%). There was a slightly increased risk of prehospital delay across the different age groups (higher in the oldest old) in those who presented with atypical rather than typical symptoms of myocardial infarction.

CONCLUSIONS: The present results provide insights to the presenting chief complaint of patients hospitalized with a first myocardial infarction according to age and the relation of symptom presentation to patient's care seeking behavior.


Care-seeking behavior, Chief complaint, Myocardial infarction

DOI of Published Version



Tisminetzky M, Gurwitz JH, Miozzo R, Nunes A, Gore JM, Lessard D, Yarzebski J, Granillo E, Goldberg RJ. Age Differences in the Chief Complaint Associated With a First Acute Myocardial Infarction and Patient's Care-Seeking Behavior. Am J Med. 2020 Mar 18:S0002-9343(20)30203-5. doi: 10.1016/j.amjmed.2020.02.018. Epub ahead of print. PMID: 32199808. Link to article on publisher's site

Journal/Book/Conference Title

The American journal of medicine

PubMed ID


Related Resources

Link to Article in PubMed