Gender differences in the management of acute chest pain

Support for the “Yentl syndrome”


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.

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Corresponding author

Correspondence to Thomas H. Lee.

Additional information

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.

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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).

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Key words

  • gender
  • exercise stress test
  • cardiac catheterization
  • resource utilization