Gender differences in the management of acute chest pain. Support for the "Yentl syndrome".
OBJECTIVE
To determine whether evaluation and management of males and females differ after presentation to the emergency department with acute chest pain.


METHODS
Prospective cohort study with follow-up at 1 month.


METHODS
Urban teaching hospital.


METHODS
The study population included 1,411 patients who were 30 years of age or older who visited the emergency department with acute chest pain from October 1990 through May 1992. These 1,411 patients represent 69% of the 2,056 patients approached for consent. The utilization of exercise stress testing as outpatients was measured for a subset of 954 patients who were interviewed at 1 month after their presentation.


RESULTS
After controlling for clinical and nonclinical predictors, women were less likely to be admitted to the hospital (adjusted odds ratio [OR] 0.68; 95% confidence interval [CI] 0.47, 0.99). Among the 954 patients with 1-month follow-up, women were less likely than men to undergo an exercise stress test during the first month after presentation, with borderline statistical significance after adjusting for the interaction between gender and admission to the hospital (adjusted OR 0.30; 95% CI 0.09, 1.0). Among the patients who were admitted to the hospital, women were as likely as men to undergo exercise stress testing (adjusted OR 0.81; 95% CI 0.57, 1.2) but were less likely to undergo cardiac catheterization (adjusted OR 0.44; 95% CI 0.25, 0.80).


CONCLUSIONS
Gender-based differences in management may occur at several stages in the evaluation of patients with acute chest pain. Observed differences in use of invasive procedures between men and women may be due in part to lower rates of exercise test use and admission to the hospital for evaluation of acute chest pain.
Johnson
P A
PA
Section for Clinical Epidemiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
Goldman
L
L
Orav
E J
EJ
Zhou
L
L
Garcia
T
T
Pearson
S D
SD
Lee
T H
TH
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D015331:Cohort Studies; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012737:Sex Factors