Sex Differences in Epidemiology, Care, and Outcomes in Patients With Acute Chest Pain

Luke P Dawson; Emily Nehme; Ziad Nehme; Esther Davis; Jason Bloom; Shelley Cox; Adam J Nelson; Daniel Okyere; David Anderson; Michael Stephenson; Jeffrey Lefkovits; Andrew J Taylor; Stephen J Nicholls; Louise Cullen; David Kaye; Karen Smith; Dion Stub

doi:10.1016/j.jacc.2022.12.025

Sex Differences in Epidemiology, Care, and Outcomes in Patients With Acute Chest Pain

J Am Coll Cardiol. 2023 Mar 14;81(10):933-945. doi: 10.1016/j.jacc.2022.12.025.

Authors

Luke P Dawson¹, Emily Nehme², Ziad Nehme³, Esther Davis⁴, Jason Bloom⁵, Shelley Cox⁶, Adam J Nelson⁴, Daniel Okyere⁷, David Anderson⁸, Michael Stephenson³, Jeffrey Lefkovits⁹, Andrew J Taylor¹⁰, Stephen J Nicholls⁴, Louise Cullen¹¹, David Kaye⁵, Karen Smith³, Dion Stub¹²

Affiliations

¹ Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
² Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia.
³ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.
⁴ Monash Heart, Victorian Heart Institute, Melbourne, Victoria, Australia.
⁵ Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Institute, Melbourne, Victoria, Australia.
⁶ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.
⁷ Ambulance Victoria, Melbourne, Victoria, Australia.
⁸ Ambulance Victoria, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
⁹ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
¹⁰ Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia.
¹¹ Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
¹² Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; The Baker Institute, Melbourne, Victoria, Australia. Electronic address: d.stub@alfred.org.au.

PMID: 36889871
DOI: 10.1016/j.jacc.2022.12.025

Abstract

Background: Discrepancies in cardiovascular care for women are well described, but few data assess the entire patient journey for chest pain care.

Objectives: This study aimed to assess sex differences in epidemiology and care pathways from emergency medical services (EMS) contact through to clinical outcomes following discharge.

Methods: This is a state-wide population-based cohort study including consecutive adult patients attended by EMS for acute undifferentiated chest pain in Victoria, Australia (January 1, 2015, to June 30, 2019). EMS clinical data were individually linked to emergency and hospital administrative datasets, and mortality data and differences in care quality and outcomes were assessed using multivariable analyses.

Results: In 256,901 EMS attendances for chest pain, 129,096 attendances (50.3%) were women, and mean age was 61.6 years. Age-standardized incidence rates were marginally higher for women compared with men (1,191 vs 1,135 per 100,000 person-years). In multivariable models, women were less likely to receive guideline-directed care across most care measures including transport to hospital, prehospital aspirin or analgesia administration, 12-lead electrocardiogram, intravenous cannula insertion, and off-load from EMS or review by emergency department clinicians within target times. Similarly, women with acute coronary syndrome were less likely to undergo angiography or be admitted to a cardiac or intensive care unit. Thirty-day and long-term mortality was higher for women diagnosed with ST-segment elevation myocardial infarction, but lower overall.

Conclusions: Substantial differences in care are present across the spectrum of acute chest pain management from first contact through to hospital discharge. Women have higher mortality for STEMI, but better outcomes for other etiologies of chest pain compared with men.

Keywords: chest pain; disparities in care; emergency medical services; quality of care; sex differences.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Chest Pain / diagnosis
Chest Pain / epidemiology
Chest Pain / therapy
Cohort Studies
Emergency Medical Services*
Female
Humans
Male
Middle Aged
ST Elevation Myocardial Infarction* / diagnosis
Sex Characteristics
Victoria / epidemiology