Differences in presentation, management and outcomes in women and men presenting to an emergency department with possible cardiac chest pain

Background Research suggests that female patients with acute coronary syndrome (ACS) experience delays in emergency department (ED) management and are less likely to receive guideline-based treatments and referrals for follow-up testing. Women are often found to have poorer clinical outcomes in comparison to men. This study aimed to assess current sex differences in the presentation, management and outcomes of patients with undifferentiated chest pain presenting to a tertiary ED. Methods Data were analysed from two prospective studies conducted at a single Australian site between 2007 and 2013. Eligible patients were those of 18 years of age or older presenting with at least five minutes of chest pain or other symptoms for which the treating physician planned to investigate for possible ACS. Characteristics of presenting symptoms, ED time measures, rates of follow-up testing and outcomes including 30-day ACS and mortality were measured and compared between male and female patients. Results Of 2349 (60% men) patients presenting with chest pain, ACS was confirmed within 30 days in 153 men and 51 women. Presenting symptoms were similar in men and women with confirmed ACS. Time from symptom onset to ED presentation, time spent in the ED and total time in hospital were similar between the sexes. Male and female patients underwent similar rates of follow-up provocative testing. Females were significantly less likely to undergo coronary angiography; after adjustment for clinical factors, the odds of undergoing angiography were 1.8 (95% CI: 1.36–2.40) times higher for men than women. Of those undergoing coronary angiography within 30 days, a smaller proportion of women, compared to men, received revascularisation. Within 30 days, three (0.2%) male and one (0.1%) female patient died. Conclusion Minimal sex differences were observed in the contemporary emergency management of patients presenting with suspected ACS, and 30-day outcomes were similarly low in men and women despite lower rates of subsequent coronary angiography and revascularisation in women. Further study is required to replicate these results in different hospital systems and cultural settings. Keywords Chest pain; Emergency; Acute coronary syndrome; Sex