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Prognosis and gender differences in chest pain patients discharged from an ED
J Herlitz1, B W Karlson, I Wiklund
1Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Insights
Women discharged from the emergency department after chest pain evaluation report more symptoms, including psychological distress, than men. These findings highlight potential gender-specific differences in symptom reporting and patient care.
Area of Science:
- Cardiology
- Emergency Medicine
- Psychology
Background:
- Chest pain is a common emergency department (ED) presentation.
- Many patients are discharged due to low probability of acute cardiac events.
- Understanding post-discharge symptoms is crucial for patient management.
Purpose of the Study:
- To investigate one-year outcomes and symptom reporting in patients discharged from the ED for chest pain.
- To identify potential gender differences in symptom experience after chest pain evaluation.
Main Methods:
- Prospective study of 5,362 patients presenting with chest pain at Sahlgrenska Hospital ED over 21 months.
- Follow-up of survivors for one year, including mailed questionnaires on symptoms.
- Analysis of one-year mortality and reported symptoms stratified by gender and cardiac disease status.
Main Results:
- 2,175 patients (40%) were discharged on initial visit. One-year mortality was 3% for both men and women.
- Patients with known cardiac disease reported more recurrent chest pain, dyspnea, and psychological symptoms.
- Female patients reported significantly more recurrent chest pain, dyspnea, psychological, and psychosomatic complaints than male patients, irrespective of cardiac disease status.
Conclusions:
- Significant gender differences exist in symptom reporting among patients discharged for chest pain.
- Women report a higher burden of chest pain, dyspnea, and psychological/psychosomatic symptoms post-discharge.
- Psychological gender differences warrant consideration in the evaluation and management of chest pain patients.
Abstract:
A large proportion of patients evaluated for chest pain in the emergency department (ED) will be sent home because the probability of acute myocardial infarction, unstable angina, or other severe disease processes is determined to be sufficiently low. Patients who came to the ED at Sahlgrenska Hospital, Göteborg during a 21-month period because of chest pain were registered and followed up for one year. Survivors after one year were asked to complete a mailed questionnaire regarding different kinds of symptoms. Of 5,362 patients evaluated in the ED, 2,175 were sent home on their first visit. Fifty-four percent were men and 46% were women. The one-year mortality rate was 3% in men and 3% in women. Recurrent chest pain, dyspnea, and psychological symptoms were more frequently reported by patients with known cardiac disease than by patients without cardiac disease. Female patients with and without cardiac disease reported significantly more frequent recurrent chest pain, dyspnea, and psychological and psychosomatic complaints than male patients with and without cardiac disease. These data suggest that there are specific gender differences between men and women who are discharged from the ED after being evaluated for chest pain. In particular, psychological gender differences may exist and need to be addressed when evaluating patients with chest pain.