title: Sex differences in patients seeking medical attention for prodromal symptoms before an acute coronary event.
abstract: BACKGROUND
  Patients with acute coronary syndromes (ACS) may experience nonspecific prodromal symptoms before their cardiac event. We used population-level data to determine the rate at which such patients seek medical attention for these symptoms, whether sex differences are present, and if an association between prodromes and 1-year mortality exists.
  
  
  METHODS
  All patients with ACS in Alberta, Canada, between April 1, 1999, and March 31, 2001, were included. Prodromes reported during all physician visits in the 90 days before ACS presentation consisted of (1) pain (chest, arm, shoulder, neck, jaw, throat, or leg); (2) anxiety/fatigue; (3) gastrointestinal disturbances; (4) head-related conditions (dizziness, headache, visual disturbances); and (5) other (sweating, shortness of breath, heart racing, cough, numbness).
  
  
  RESULTS
  Of 14,230 patients with ACS, 2,268 (15.9%, 45.6% women) sought medical attention for at least one prodrome, with pain and anxiety/fatigue most common. Prodromes were associated with increased cardiac investigations before ACS in both sexes. After adjustment for baseline characteristics, a significant interaction between sex and prodromes was found (P [interaction] = .011). Prodromes were associated with improved 1-year survival in women (adjusted hazard ratio [HR] 0.74, 95% CI 0.58-0.95, P = .016, risk-adjusted mortality 8.7% vs 11.1% [without prodromes], P < .001) but not in men (adjusted hazard ratio 0.92, 95% CI 0.76-1.12, P = .422, 9.9% [with prodromes] vs 9.1% [without prodromes], P = .358).
  
  
  CONCLUSIONS
  A small proportion of patients with ACS seek medical attention for prodromal symptoms in the 90 days before ACS. Seeking help for these symptoms is associated with improved survival in women but not in men.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. michelle.m.graham@capitalhealth.ca
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Graham
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Westerhout
authors.forename: Padma
authors.initials: P
authors.lastname: Kaul
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Norris
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
mesh_terms: D000367:Age Factors; D000368:Aged; D000416:Alberta; D000789:Angina, Unstable / Q000175:diagnosis* / Q000401:mortality; D015897:Comorbidity; D042241:Early Diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012737:Sex Factors; D016019:Survival Analysis