title: Sex differences in investigation results and treatment in subjects referred for investigation of chest pain.
abstract: OBJECTIVE
  To evaluate differences in investigation results and treatment between men and women referred for diagnostic treadmill exercise testing and coronary arteriography.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Tertiary cardiology centre.
  
  
  METHODS
  1522 subjects referred by primary care physicians to an open access chest pain clinic for initial investigation of chest pain, of whom 485 were subsequently referred for coronary arteriography; and a similar cohort of 107 subjects referred directly by secondary care physicians for diagnostic coronary arteriography.
  
  
  METHODS
  Rates of positive exercise tests and rates for referral for arteriography and revascularisation according to sex.
  
  
  RESULTS
  Overall, women were less likely to be referred for arteriography and revascularisation than men. However, men were more likely to have positive exercise tests, and for various exercise test diagnostic end points men were also more likely to have significant coronary artery disease. After taking this into account, there was no sex difference in referral rates for arteriography or revascularisation.
  
  
  CONCLUSIONS
  There was no evidence of a sex bias resulting in inappropriate underinvestigation or undertreatment of women. However, the positive predictive value of treadmill exercise testing is low for women and further research is needed into how best to investigate women with chest pain.
authors.affiliation: Wessex Regional Cardiac Unit, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Wong
authors.forename: A
authors.initials: A
authors.lastname: Rodwell
authors.forename: S
authors.initials: S
authors.lastname: Dawkins
authors.forename: S A
authors.initials: SA
authors.lastname: Livesey
authors.forename: I A
authors.initials: IA
authors.lastname: Simpson
mesh_terms: D000368:Aged; D016507:Cardiology Service, Hospital; D002637:Chest Pain / Q000209:etiology*; D015331:Cohort Studies; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000628:therapy; D004739:England; D005080:Exercise Test; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D010043:Outcome and Process Assessment, Health Care; D018710:Pain Clinics; D011237:Predictive Value of Tests; D011287:Prejudice; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012737:Sex Factors