OBJECTIVE: To determine whether evaluation and management of males and females differ after presentation to the emergency department with acute chest pain.
DESIGN: Prospective cohort study with follow-up at 1 month.
SETTING: Urban teaching hospital.
PATIENTS: 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.
MEASUREMENTS/MAIN 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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991;325:221–5.
Bickell NA, Pieper DS, Lee LK, et al. Referral patterns for coronary artery disease treatment: gender bias or good clinical judgment? Ann Intern Med. 1992;116:791–7.
Krumholz HM, Douglas PS, Lauer MS, et al. Selection of patients for coronary angiography and coronary revascularization early after myocardial infarction: Is there evidence for gender bias? Ann Intern Med. 1992;116:785–90.
Tobin JN, Wassertheir-Smoller S, Wexler JP, et al. Sex bias in considering coronary bypass surgery. Ann Intern Med. 1987;107:19–25.
Maynard C, Litwin PE, Martin JS, et al. Gender differences in the treatment and outcome of acute myocardial infarction: results from the Myocardial Infarction Triage and Intervention Registry. Arch Intern Med. 1992;152:972–6.
Steingart RM, Packer M, Hamm P, et al. Sex differences in the management of coronary artery disease. N Engl J Med. 1991;325:226–30.
Maynard C, Althouse R, Cerqueira M, et al. Underutilization of thrombolytic therapy in eligible women with acute myocardial infarction. Am J Cardiol. 1991;68:529–30.
Pfeffer MA, Moye LA, Braunwald E, et al. Selection bias in the use of thrombolytic therapy in acute myocardial infarction. JAMA. 1991;266:528–32.
Udvarhelyi IS, Gatsonis C, Epstein AM, et al. Acute myocardial infarction in the Medicare population. JAMA. 1992;268:2530–6.
Shaw LJ, Miller DD, Romeis JC, et al. Gender differences in the noninvasive evaluation and management of patients with suspected coronary artery disease. Ann Intern Med. 1994;120:559–66.
Khan SS, Nessim S, Gray R, et al. Increased mortality of women in coronary artery bypass surgery: evidence for referral bias. Ann Intern Med. 1990;112:561–7.
King KB, Clark PC, Hicks GL. Pattern of referral and recovery in women and men undergoing coronary artery bypass grafting. Am J Cardiol. 1992;69:179–82.
Kelsey SF, James M, Holubkov AL, et al. Results of percutaneous transluminal coronary angioplasty in women; 1985–1986 National Heart, Lung, and Blood Institute’s Coronary Angioplasty Registry. Circulation. 1993;87:720–7.
Weintraub WS, Craver JM, Cohen CL, et al. Influence of age on results of coronary artery surgery. Circulation. 1991;84(Suppl III):III-226-35.
Gardner TJ, Horneffer PJ, Gott VL, et al. Coronary artery bypass grafting in women: a ten-year perspective. Ann Surg. 1985;201:780–3.
Christakis GT, Ivanov J, Weisel RD, et al. The changing pattern of coronary artery bypass surgery. Circulation. 1989;80(Suppl I):I-151-61.
Eaker ED, Dronmal R, Kennedy JW, et al. Comparison of the long-term, postsurgical survival of women and men in the Coronary Artery Surgery Study (CASS). Am Heart J. 1989;117:71–80.
Higgins TL, Estafanous FG, Loop FD, et al. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients: a clinical severity score. JAMA. 1991;267:2344–8.
Eysmann SB, Douglas PS. Reperfusion and revascularization strategies for coronary artery disease in women. JAMA. 1992;268:1903–7.
Healy B. The Yentl syndrome. N Engl J Med. 1991;325:274–5.
Goldman L, Hashimoto B, Cook EF, et al. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation. 1981;64:1227.
Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373.
Goldman L, Cook EF, Brand DA, et al. A computer protocol to predict myocardial infarction in emergency department patients with chest pain. N Engl J Med. 1988;318:797.
From the Section for Clinical Epidemiology, the Division of General Medicine, and the Cardiovascular Division, Department of Medicine, and the Department of Emergency Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts.
Supported in part by a grant from the Agency for Health Care Policy and Research (RO1-HS06452). Dr. Paula Johnson was the recipient of a Clinician-Scientist Award (91004160) at the time of this study and is now the recipient of a Minority Faculty Development Award from the Robert Wood Johnson Foundation. Dr. Thomas Lee was the recipient of an Established Investigator Award (900119) from the American Heart Association.
About this article
Cite this article
Johnson, P.A., Goldman, L., Orav, E.J. et al. Gender differences in the management of acute chest pain. J Gen Intern Med 11, 209–217 (1996). https://doi.org/10.1007/BF02642477
- exercise stress test
- cardiac catheterization
- resource utilization