Related Experiment Videos
Gender differences in the presentation, treatment, and short-term mortality of acute chest pain
R D Gregor1, I R Bata, B J Eastwood
1Department of Medicine, Dalhousie University, Halifax, Nova Scotia.
Insights
This study found women with acute chest pain had different risk factors and less invasive testing than men. However, adjusted 28-day mortality was similar, suggesting clinical conditions explained most differences.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Acute chest pain presentation and management can exhibit gender disparities.
- Understanding these differences is crucial for equitable cardiovascular care.
Purpose of the Study:
- To investigate gender bias in the presentation, treatment, and outcomes of acute chest pain patients.
- To analyze differences in risk factors, diagnostic procedures, and mortality between men and women.
Main Methods:
- Utilized the Halifax County MONICA database (1984-1990) for patients aged 25-74 with acute chest pain.
- Compared demographic data, medical history, symptom presentation, pre-hospital and in-hospital treatments, and 28-day mortality between genders.
- Adjusted for clinical conditions to assess their impact on observed differences.
Main Results:
- Women were older, more likely to have diabetes, hypertension, and peripheral vascular disease.
- Typical infarction symptoms were less frequent in women (30.8%) compared to men (38.1%).
- Women received more non-antiarrhythmic medications but less coronary arteriography and exercise stress tests; men had more severe arrhythmias. Adjusted 28-day mortality was 9.6% for women vs. 7.8% for men.
Conclusions:
- Gender-based differences exist in acute chest pain presentation, risk factors, and diagnostic procedures.
- While treatment patterns and invasive testing varied by gender, clinical conditions largely explained the 28-day mortality differences.
Abstract:
The Halifax County MONICA database was used to estimate the gender bias in presentation, prehospital and in-hospital treatment, and 28-d mortality of patients suffering an episode of acute chest pain. The study population consisted of all county residents aged 25-74, admitted between 1984 and 1990 to a CCU, or suffering a myocardial infarction anywhere in a hospital. The mean age for men was 58.5 (n = 6561), for women 61.5 (n = 3176). Women of all age groups were more likely to have a history of diabetes or hypertension, and below age 55 had a higher prevalence of peripheral vascular disease. Typical symptoms for infarction were present in 30.8% of women and 38.1% of men (p < 0.0001). More women were taking beta-blockers, Ca-antagonists, digitalis, diuretics, and nitrates (p < 0.001), and more men were on antiarrhythmics. A gender difference was observed for coronary arteriography (24% in men, 18% in women) and for the exercise stress test (23% in men, 18% in women). In hospital, men had more episodes of severe arrhythmias (OR = 1.52). Except for aspirin and antiarrhythmics, the difference in hospital medication and 28-d mortality (9.6% in women vs. 7.8% in men) could be explained by the existing clinical conditions.