title: Differences in Presentation, Management and Outcomes in Women and Men Presenting to an Emergency Department With Possible Cardiac Chest Pain.
abstract: 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 2014. Eligible patients were those of 18 years of age or older presenting with at least 5 minutes of chest pain or other symptoms for which the treating physician planned to investigate for possible ACS. Presenting symptoms, ED time measures, 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, 153 men and 51 women were diagnosed with ACS within 30days . 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 had similar rates of follow-up provocative testing. 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.
  
  
  CONCLUSIONS
  Minimal sex differences were observed in the contemporary emergency management of patients presenting with suspected ACS. Thirty-day outcomes were similarly low in men and women despite lower rates of coronary angiography and revascularisation in women. Further research is required to replicate these results in different hospital systems and cultural settings.
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Qld, Australia.
authors.forename: Lorcan
authors.initials: L
authors.lastname: Ruane
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Qld, Australia; School of Public Health, Queensland University of Technology, Brisbane, Qld, Australia; Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
authors.forename: Jaimi
authors.initials: J
authors.lastname: H Greenslade
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Qld, Australia; School of Public Health, Queensland University of Technology, Brisbane, Qld, Australia; Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Parsonage
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
authors.forename: Tracey
authors.initials: T
authors.lastname: Hawkins
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hammett
authors.affiliation: National Heart Centre Singapore, Singapore; Duke-National University of Singapore, Singapore.
authors.forename: Carolyn Sp
authors.initials: CS
authors.lastname: Lam
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Qld, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Knowlman
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Qld, Australia.
authors.forename: Shaela
authors.initials: S
authors.lastname: Doig
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Qld, Australia; School of Public Health, Queensland University of Technology, Brisbane, Qld, Australia; Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia. Electronic address: louise.cullen@health.qld.gov.au.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D019468:Disease Management; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011446:Prospective Studies; D011793:Queensland / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D017678:Sex Distribution; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Chest pain; Emergency; Sex