Differences in presentation, management and outcomes in women and men presenting to an emergency department with possible cardiac chest pain

Ruane, Lorcan, Greenslade, Jaime H. , Parsonage, William, Hawkins, Tracey, Hammett, Christopher, Lam, Carolyn S. P. , Knowlman, Thomas, Doig, Shaela and Cullen, Louise (2017) Differences in presentation, management and outcomes in women and men presenting to an emergency department with possible cardiac chest pain. Heart, Lung and Circulation, . doi:10.1016/j.hlc.2017.01.003


Author Ruane, Lorcan
Greenslade, Jaime H.
Parsonage, William
Hawkins, Tracey
Hammett, Christopher
Lam, Carolyn S. P.
Knowlman, Thomas
Doig, Shaela
Cullen, Louise
Title Differences in presentation, management and outcomes in women and men presenting to an emergency department with possible cardiac chest pain
Journal name Heart, Lung and Circulation   Check publisher's open access policy
ISSN 1444-2892
1443-9506
Publication date 2017-02-17
Sub-type Article (original research)
DOI 10.1016/j.hlc.2017.01.003
Open Access Status Not yet assessed
Total pages 9
Place of publication Chatswood, NSW, Australia
Publisher Elsevier Australia
Collection year 2018
Language eng
Formatted abstract
Background: Research suggests that female patients with acute coronary syndrome (ACS) experience delays in emergency department (ED) management and are less likely to receive guideline-based treatments and referrals for follow-up testing. Women are often found to have poorer clinical outcomes in comparison to men. This study aimed to assess current sex differences in the presentation, management and outcomes of patients with undifferentiated chest pain presenting to a tertiary ED.

Methods: Data were analysed from two prospective studies conducted at a single Australian site between 2007 and 2014. Eligible patients were those of 18 years of age or older presenting with at least five minutes of chest pain or other symptoms for which the treating physician planned to investigate for possible ACS. Presenting symptoms, ED time measures, follow-up testing and outcomes, including 30-day ACS and mortality, were measured and compared between male and female patients.

Results: Of 2349 (60% men) patients presenting with chest pain, 153 men and 51 women were diagnosed with ACS within 30. days Presenting symptoms were similar in men and women with confirmed ACS. Time from symptom onset to ED presentation, time spent in the ED and total time in hospital were similar between the sexes. Male and female patients had similar rates of follow-up provocative testing. After adjustment for clinical factors, the odds of undergoing angiography were 1.8 (95% CI: 1.36-2.40) times higher for men than women. Of those undergoing coronary angiography within 30 days, a smaller proportion of women, compared to men, received revascularisation. Within 30 days, three (0.2%) male and one (0.1%) female patient died.

Conclusion: Minimal sex differences were observed in the contemporary emergency management of patients presenting with suspected ACS. 30-day outcomes were similarly low in men and women despite lower rates of coronary angiography and revascularisation in women. Further research is required to replicate these results in different hospital systems and cultural settings.
Keyword Acute coronary syndrome
Chest pain
Emergency
Sex
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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