Year: 2026 | Month: May | Volume: 16 | Issue: 5 | Pages: 141-149
DOI: https://doi.org/10.52403/ijhsr.20260517
Clinical Profile of Acute Coronary Syndromes in Elderly in a Rural Population: A Retrospective Observational Study
Nijora Deka1, Satish Talikoti2
1Professor and Head, Department of General Medicine, S.R. Patil Medical College, Hospital and Research Centre, Badagandi, Bagalkot, India
2Associate Professor, Department of General Medicine, S.R. Patil Medical College, Hospital and Research Centre, Badagandi, Bagalkot, India
Corresponding Author: Dr. Nijora Deka
ABSTRACT
Background: Elderly patients with acute coronary syndrome (ACS) frequently present with atypical symptoms and delayed hospital arrival. In rural settings, these challenges are further compounded by transport difficulties, limited health awareness, and the practical barriers that determine when and how patients reach a first-contact facility.
Aim: To describe the clinical presentation, cardiovascular risk profile, glycaemic and lipid status, comorbidity burden, ECG territory distribution, troponin I levels, and bedside echocardiographic findings in elderly ACS patients seen at a rural first-contact centre, and to compare these profiles by sex, time of presentation, and ACS type.
Methods: This retrospective observational study included 120 elderly patients aged 60 years and above presenting with ACS over a one-year period at a rural tertiary care teaching hospital functioning as a first-contact and stabilisation centre without on-site catheterisation facilities. Clinical presentation, risk factors, ECG findings, troponin I levels, and bedside echocardiographic findings were recorded. Categorical variables were summarised as frequencies and percentages, and associations with atypical and delayed presentation were assessed by Chi-square or Fisher's exact test. Statistical significance was set at p<0.05.
Results: Typical chest pain was present in 84/120 patients (70.0%); 36/120 (30.0%) presented without typical chest pain. STEMI accounted for 90.0% of ECG presentations, with anterior territory most frequent (43.3%). Troponin I was positive in 93.3% of patients, and markedly elevated in 42.9% of those positive. Hypertension (33.3%), alcohol use (45.0%), tobacco exposure (30.0%), and diabetes mellitus (26.7%) were the predominant risk factors; 43.3% had fasting blood glucose above 126 mg/dL. Bedside echocardiography was performed in 44 patients with markedly elevated troponin; 90.9% showed regional wall motion abnormalities and 54.5% had moderate-to-severe LV systolic dysfunction. Atypical presentation was significantly more common among women (p=0.003), and delayed presentation was significantly associated with higher clinical acuity at referral (p=0.010).
Conclusion: Elderly ACS at a rural first-contact centre is dominated by STEMI, atypical presentation, and delayed arrival. Women were more likely to present without chest pain. These findings point to a clear need for better community awareness and more responsive referral pathways in rural settings.
Key words: acute coronary syndrome; elderly; rural population; atypical presentation; delayed presentation; first-contact care