Atypical presentations among Medicare beneficiaries with unstable XXXX .

@entity662 @entity1 @entity390 @entity1007 @entity1242 @entity1353 @entity303 @entity117 @entity11728 @entity27915 @entity1163 @entity951 @entity158 @entity299 @entity583
@entity662 is a hallmark symptom in @entity1 with unstable @entity951 (UAP). However, little is known regarding the prevalence of an atypical presentation among these @entity1 and its relation to subsequent care. We examined the medical records of 4,167 randomly sampled Medicare @entity1 hospitalized with unstable @entity951 at 22 Alabama hospitals between 1993 and 1999. We defined typical presentation as (1) @entity662 located substernally in the left or right chest, or (2) @entity662 characterized as squeezing, tightness, @entity158 , crushing, arm discomfort, dullness, @entity27915 , @entity11728 , pressure, or @entity158 aggravated by exercise or relieved with rest or @entity1242 . Atypical presentation was defined as confirmed UAP without typical presentation. Among @entity1 with confirmed UAP, 51.7% had atypical presentations. The most frequent symptoms associated with atypical presentation were @entity1353 (69.4%), @entity390 (37.7%), diaphoresis (25.2%), @entity1163 (10.6%), or @entity158 in the arms (11.5%), epigastrium (8.1%), shoulder (7.4%), or neck (5.9%). Independent predictors of atypical presentation for @entity1 with UAP were older age (odds ratio 1.09, 95% confidence interval 1.01 to 1.17/decade), history of @entity303 (odds ratio 1.49, 95% confidence interval 1.10 to 2.03), and absence of prior @entity583 , @entity1007 , or family history of @entity299 . @entity1 with atypical presentation received @entity117 , heparin, and beta-blocker therapy less aggressively, but there was no difference in mortality. Thus, over half of Medicare @entity1 with confirmed UAP had "atypical" presentations. National educational initiatives may need to redefine the classic presentation of UAP to include atypical presentations to ensure appropriate quality of care.
