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

https://doi.org/10.1016/j.jacc.2022.12.025Get rights and content
Under an Elsevier user license
open archive

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.

Key Words

chest pain
disparities in care
emergency medical services
quality of care
sex differences

Abbreviations and Acronyms

ACS
acute coronary syndrome(s)
CCU
cardiac care unit
ECG
electrocardiogram
ED
emergency department
EMS
emergency medical services
ICU
intensive care unit
IRR
incidence rate ratio
IV
intravenous
NSTEMI
non–ST-segment elevation myocardial infarction
STEMI
ST-segment elevation myocardial infarction

Cited by (0)

Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on www.jacc.org/journal/jacc.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.