title: Influence of sex on the out-of-hospital management of chest pain.
abstract: BACKGROUND
  Sex disparities in the diagnosis and treatment of chest pain or suspected angina have been demonstrated in multiple clinical settings. Out-of-hospital (OOH) care for chest pain is protocol-driven and may be less likely to demonstrate differences between men and women.
  
  
  OBJECTIVE
  The objectives were to investigate the relationship between sex and the OOH treatment of patients with chest pain. The authors sought to test the hypothesis that OOH care for chest pain patients would differ by sex.
  
  
  METHODS
  A 1-year retrospective cohort study of 683 emergency medical services (EMS) patients with a complaint of chest pain was conducted. Included were patients taken to any one of three hospitals (all cardiac referral centers) by a single municipal EMS system. Excluded were patients transported by basic life support (BLS) units, those younger than 30 years, and patients with known contraindications to any of the outcome measures. Multivariable regression was used to adjust for potential confounders. The main outcome was adherence to state EMS protocols for treatment of patients over age 30 years with undifferentiated chest pain. Rates of administration of aspirin, nitroglycerin, and oxygen; establishment of intravenous (IV) access; and cardiac monitoring were measured.
  
  
  RESULTS
  A total of 342 women and 341 men were included. Women were less likely than men to receive aspirin (relative risk [RR] = 0.76; 95% confidence interval [CI] = 0.59 to 0.96), nitroglycerin (RR = 0.76; 95% CI = 0.60 to 0.96), or an IV (RR 0.86; 95% CI = 0.77 to 0.96). These differences persisted after adjustment for demographics and emergency department (ED) evaluation for acute coronary syndrome (ACS) as a blunt marker for cardiac risk. Women were also less likely to receive these treatments among the small subgroup of patients who were later diagnosed with acute myocardial infarction (AMI).
  
  
  CONCLUSIONS
  For OOH patients with chest pain, sex disparities in treatment are significant and do not appear to be explained by differences in patient age, race, or underlying cardiac risk.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. zachary.meisel@uphs.upenn.edu
authors.forename: Zachary F
authors.initials: ZF
authors.lastname: Meisel
authors.forename: Katrina
authors.initials: K
authors.lastname: Armstrong
authors.forename: C Crawford
authors.initials: CC
authors.lastname: Mechem
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.forename: Nick
authors.initials: N
authors.lastname: Peacock
authors.forename: Kim
authors.initials: K
authors.lastname: Facenda
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology / Q000628:therapy; D001241:Aspirin / Q000627:therapeutic use; D002637:Chest Pain / Q000453:epidemiology / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D005996:Nitroglycerin / Q000627:therapeutic use; D012044:Regression Analysis; D012189:Retrospective Studies; D012737:Sex Factors; D014665:Vasodilator Agents / Q000627:therapeutic use; D016387:Women's Health
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin; D001241:Aspirin