Sex differences in acute chest pain care in a multisite U.S. emergency department cohort
Kyle H McKnight1, Anna C Snavely2, Lyle Paukner2
1Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Insights
Women experienced lower rates of death, myocardial infarction (MI), hospitalizations, and cardiac testing within 30 days compared to men in emergency departments. This study highlights significant sex-based differences in cardiovascular care utilization and outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Limited large-scale studies address sex-based disparities in emergency department (ED) cardiovascular care.
- This research analyzes sex differences in cardiovascular healthcare utilization and safety outcomes within a U.S. cohort using a standardized high-sensitivity troponin (hs-cTn) pathway.
Purpose of the Study:
- To compare cardiovascular healthcare utilization and safety outcomes between women and men presenting to the ED with chest pain.
- To investigate sex-based differences in 30-day mortality, myocardial infarction (MI), hospitalizations, and objective cardiac testing (OCT).
Main Methods:
- An observational study included 40,979 adult patients presenting with chest pain across 25 EDs from January to December 2021.
- Outcomes including 30-day death or MI, hospitalizations, and OCT were compared between sexes using chi-squared tests and adjusted logistic regression, controlling for confounders and initial hs-cTn levels.
Main Results:
- Women (56.6%) had significantly lower rates of 30-day death or MI (2.4% vs. 5.2%, adjusted OR [aOR] 0.65) compared to men.
- Women experienced lower 30-day hospitalization rates (30.2% vs. 36.0%, aOR 0.93) and underwent less objective cardiac testing (14.9% vs. 19.6%, aOR 0.93) than men.
- These differences persisted after adjusting for cardiovascular disease risk factors and initial hs-cTn levels.
Conclusions:
- In a large ED cohort, women with chest pain exhibited lower rates of 30-day death or MI, hospitalizations, and objective cardiac testing compared to men.
- The findings underscore significant sex-based variations in cardiovascular care delivery and outcomes in the emergency setting.
Background:
Large studies examining sex-based differences in emergency department (ED) cardiovascular care are lacking. This analysis compared cardiovascular healthcare utilization and safety outcomes between women and men in a large U.S. cohort managed under a standardized high-sensitivity troponin (hs-cTn) pathway.
Methods:
We conducted an observational study of ED patients ≥18 years old presenting with chest pain from 1/2021-12/2021 across 25 EDs. Sex was defined by the legal sex EHR variable. The primary safety outcome was 30-day all-cause death or myocardial infarction (MI). The primary healthcare utilization outcome was hospitalizations at 30 days. Secondary healthcare utilization outcomes included 30-day objective cardiac testing (OCT: stress testing, coronary computed tomography angiography, invasive coronary angiography). Outcomes were compared between sexes using chi-squared tests and logistic regression, where models adjusted for cardiovascular disease confounders and initial hs-cTn.
Results:
Among 40,979 patients, 56.6% (23,188/40,979) were female with mean age 52. Death or MI at 30 days occurred in 2.4% (552/23,188) of women and 5.2% (917/17,791) of men (p < 0.001). After adjustment, women had lower odds of death or MI (aOR 0.65, 95% CI 0.57-0.74). Hospitalizations occurred in 30.2% (6998/23,188) of women compared to 36.0% (6411/17,791) of men (p < 0.001). OCT occurred in 14.9% (3452/23,188) of women and 19.6% (3488/17,791) of men (p < 0.001). With adjustment, women were hospitalized less (aOR 0.93, 95% CI 0.88-0.98) and underwent less OCT (aOR 0.93, 95% CI 0.87-0.98) at 30-days.
Conclusion:
In a large ED cohort of patients with chest pain, rates of death or MI, hospitalizations, and OCT at 30-days were lower in women compared to men.
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