Differences in Presentation, Management and Outcomes in Women and Men Presenting to an Emergency Department With Possible Cardiac Chest Pain

Ruane, L.; Greenslade, J.; Parsonage, William; Hawkins, Tracey; Hammett, C.; Lam, Carolyn S.P.; Knowlman, Thomas; Doig, Shaela; Cullen, Louise

doi:10.1016/j.hlc.2017.01.003

Cited by 16 publications

(15 citation statements)

References 39 publications

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“…Elevated body mass index, dyslipidemia, smoking and a history of coronary artery disease were more prevalent in men. These results are similar to more recent data of cohorts with patients suggestive of ACS …”

Section: Discussionsupporting

confidence: 92%

“…Furthermore, there was no significant sex‐specific difference in time from onset of symptoms to admission at the emergency department in our cohort. Former studies consistently showed longer time from onset of symptoms to presentation to emergency department for women, whereas in more recent data, the time delay until hospital admission for women with ACS has diminished and may indicate beneficial trends in ACS management in women …”

Section: Discussionmentioning

confidence: 97%

“…These results are similar to more recent data of cohorts with patients suggestive of ACS. 24,25 Previous studies suggested that women with ACS more often present with "atypical" symptoms, in particular with absence of typical chest pain. 3,4,26 In our analyses, the majority of both sexes had some kind of chest pain.…”

Section: Clinical Presentationmentioning

confidence: 99%

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Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome

Sörensen

Neumann

Ojeda³

et al. 2018

JAHA

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BackgroundThe atypical presentation of women with acute coronary syndrome (ACS) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men.Methods and ResultsWe analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of ACS. Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately. Sex‐specific differences in management of patients with ACS were ascertained and a 2‐year follow‐up was performed. Women were older than men (median 67 versus 61 years, P=0.001), had more often dyspnea (22% versus 18%, P=0.024), nausea or vomiting (26% versus 16%, P=0.001) and radiating chest pain (47% versus 40%, P=0.001). Classical risk factors (smoking, diabetes mellitus, dyslipidemia or known coronary artery disease) were less frequent in women. Diagnostic models showed no significant sex‐related differences in diagnostic performance in a “first contact” setting (medical history and symptoms) or after “complete triage” (including ECG and biomarkers). Women with ACS underwent coronary angiography (73.8% versus 84.3%, P<0.001) and revascularization (53.8% versus 70.1%, P<0.001) less frequently. Two‐year incidence of myocardial infarction and death was similar in both sexes, but revascularization and cardiac rehospitalization were more frequent in men.ConclusionsIn a large cohort of patients with suspected ACS, sex differences in clinical presentation did not impair diagnostic accuracy. Two‐year outcomes were comparable. Our findings suggest a benefit of chest pain units to minimize sex differences in ACS management and prognosis.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifiers: NCT02355457 (BACC), NCT03227159 (stenoCardia).

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

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Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome

Sörensen

Neumann

Ojeda³

et al. 2018

JAHA

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“…Despite higher rates of ACS in men, there were substantial sex differences in treatment strategies. We and others [ 16 , 19 , 20 ] showed that women presenting to the emergency department with chest pain were less likely to undergo invasive diagnostic tests. Although about 90% of patients with ACS present with chest pain or discomfort, some patients do not suffer from typical chest pain [ 21 ].…”

Section: Discussionmentioning

confidence: 98%

Sex-Specific Outcomes in Patients with Acute Coronary Syndrome

Neumann

Goßling²,

Sörensen

et al. 2020

JCM

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Sex differences in patients with acute coronary syndrome (ACS) are a matter of debate. We investigated sex-specific differences in the incidence, outcomes, and related interventions in patients diagnosed with ACS in Germany over the past decade. All ACS cases from 2005 to 2015 were collected. Procedures and inhospital mortality were assessed by sex. Age-adjusted incidence rates were calculated. In total, 1,366,045 females and 2,431,501 males presenting with ACS were recorded. Females were older than males (73.1 vs. 66.4 years of age), had a longer mean hospital stay (7.7 vs. 6.9 days), and less frequently underwent coronary angiographies (55% vs. 66%) and coronary interventions (35% vs. 47%). The age-adjusted incidence rate of ACS was lower in females than in males, and decreased in both sexes from 2005 to 2015. The age-adjusted inhospital mortality rate was substantially higher in females than in males, but decreased in both sexes over time (in females, from 87 to 71 cases per 1000 person years; in males, from 57 to 51 cases per 1000 person years). In conclusion, we reported sex differences in the incidence, treatment, and outcomes of ACS patients in Germany within the past decade. Women had a substantially higher mortality rate and lower rate of coronary interventions.

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“…The median duration of illness prior to hospital presentation was seven days, indicating that even those who seek hospital care for such symptoms do not do so promptly. Such delayed presentation stands in stark contrast to care-seeking behavior in high income countries, where median presentation times for patients with chest pain or other potential ACS symptoms are typically less than four hours [6,28]. Even in other low-and middle-income countries (LMICs) such as Pakistan and India, the majority of patients with possible ACS symptoms presented to hospital within 12 hours [1,20].…”

Section: Discussionmentioning

confidence: 99%

Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital

Hertz

Kweka

Bloomfield

et al. 2020

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Background: Acute coronary syndrome (ACS) is thought to be a rare diagnosis in sub-Saharan Africa, but little is known about diagnostic practices for patients with possible ACS symptoms in the region. Objective: To describe current care practices for patients with ACS symptoms in Tanzania to identify factors that may contribute to ACS under-detection. Methods: Emergency department patients with chest pain or shortness of breath at a Tanzanian referral hospital were prospectively observed. Medical histories were obtained, and diagnostic workups, treatments, and diagnoses were recorded. Five-year risk of cardiovascular events was calculated via the Harvard National Health and Nutrition Examination Survey risk score. Telephone follow-ups were conducted 30 days after enrollment. Results: Of 339 enrolled patients, the median (IQR) age was 60 (46, 72) years, 252 (74.3%) had hypertension, and 222 (65.5%) had >10% five-year risk of cardiovascular event. The median duration of symptoms prior to presentation was 7 days, and 314 (92.6%) reported symptoms worsened by exertion. Of participants, 170 (50.1%) received an electrocardiogram, and 9 (2.7%) underwent cardiac biomarker testing. There was no univariate association between five-year cardiovascular risk and decision to obtain an electrocardiogram (p = 0.595). The most common physician-documented diagnoses were symptomatic hypertension (104 patients, 30.7%) and heart failure (99 patients, 29.2%). Six patients (1.8%) were diagnosed with ACS, and 3 (0.9%) received aspirin. Among 284 (83.8%) patients completing 30-day follow-up, 20 (7.0%) had died. Conclusions: Many patients with ACS risk factors present to the emergency department of a Tanzanian referral hospital with possible ACS symptoms, but marked delays in care-seeking are common. Complete diagnostic workups for ACS are uncommon, ACS is rarely diagnosed or treated with evidence-based therapies, and mortality in patients with these symptoms is high. Physician practices may be contributing to ACS under-detection in Tanzania, and interventions are needed to improve ACS care.

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Differences in Presentation, Management and Outcomes in Women and Men Presenting to an Emergency Department With Possible Cardiac Chest Pain

Cited by 16 publications

References 39 publications

Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome

Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome

Sex-Specific Outcomes in Patients with Acute Coronary Syndrome

Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital

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