Chest pain: sex disparities in care begin at ED triage

  • Mnatzaganian G & al.
  • Heart
  • 25 Sep 2019

  • International Clinical Digest
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Takeaway

  • Stark disparities marked earliest stages of emergency department (ED) assessment, management of women vs men with chest pain.
  • Women died at higher rates.

Why this matters

  • Coronary artery disease (CAD) kills 15% of women.
  • Sex-based disparities in CAD outcomes have been extensively documented.
  • Few previous data addressed triage categorization or delay in time to medical examination.

Key results

  • 34.5% of presentations were cardiac.
  • Upon multivariable analysis, women vs men (ORs; 95% CIs):
    • Urgent triage allocation (immediate or within 10 minutes):
      • Age 18-54 years: 0.79 (0.76-0.83).
      • Age ≥55 years: 0.90 (0.86-0.95).
    • Examination within 1 hour: 
      • Age 18-54 years: 0.85 (0.81-0.89).
      • Age ≥55 years: 0.83 (0.79-0.87).
    • Troponin performed:
      • Age 18-54 years: 0.73 (0.70-0.77).
      • Age ≥55 years: 0.91 (0.87-0.97).
    • Critical care admission: 
      • Age 18-54 years: 0.69 (0.62-0.77).
      • Age ≥55 years: 0.66 (0.62-0.71).
    • All above, P<.001.>
    • In-ED death: 1.35 (1.02-1.79; P=.039).
    • In-hospital death: 1.36 (1.12-1.66; P=.002).
  • Similar results upon sensitivity analyses.

Study design

  • Retrospective study of 3 EDs in Melbourne, Australia, 2009-2013.
  • Researchers assessed multiple care measures, outcomes among 54,138 adults with nontraumatic chest pain (76,216 presentations).
  • Funding: None.

Limitations

  • No data on post-ED medical management.

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