Less care for young women with chest pain in the emergency department?

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For those up to the age of 55 who go to hospital emergency services with chest pain in the United States, women are less likely than men to be selected as urgent and receive a electrocardiogram (ECG), or be seen by a consultant, according to a new study.

In addition, women waited 10 minutes longer than men to see a filmmaker and were 40% less likely to be hospitalized, according to the results.


Darcy Bank

Lead author Darcy Banco, MD, MPH, a resident in internal medicine at NYU Langone Health in New York City, reported on these findings during a press conference and will present the study at the scientific session of the American College of Cardiology 2021.

“Lower admission rates and tests on young women increase the chance of losing heart attacks,” she stressed.

Doctors should be aware that chest pain is still the most common symptom in women with myocardial infarction, although women sometimes describe pain as pressure or discomfort. Women are also more likely to have secondary symptoms, such as shortness of breath, nausea, vomiting, and back pain – that cloud the image, she pointed out.

The results highlight that doctors “should not rule out heart attack as a possible explanation for chest pain” just because a patient is younger or is a woman, Banco said theheart.org | Cardiology Medscape.

Myocardial infarction (MI) is not known to be an “excessively common diagnosis among young adults,” he said, but it is a “not to be missed” diagnosis, and young women who have an MI have worse outcomes than young men, he pointed out.

“Not all young women [with chest pain] whoever proves to have a heart attack will have the typical risk factors that become a red flag when they are evaluated in the emergency department, “said lead author Harmony Reynolds, MD, a cardiologist at NYU Langone Health. Some patients Young people with chest pain may have spontaneous dissection of the coronary artery, which, although uncommon, is more common in young women.

“Women should trust their instincts,” Banco said in a statement. They “should seek care immediately if they experience chest discomfort, difficulty breathing, nausea, vomiting, fatigue, sweating, or back pain, as they may be signs of a heart attack. The most important thing a woman can do is seek care. if you are concerned and ask your doctor specific questions. “

“While the responsibility should never fall on the patient, women should consider asking,‘ Do I have a heart attack? How can you be sure? “Advised Bank.

The study highlights that doctors “need to take symptoms in a woman more seriously and we should not discriminate on the basis of gender.” echoed theheart.org | Cardiology Medscape.

It would have been interesting, he added, to know if the amount of additional testing and work was justified based on TIMI or GRACE risk scores, which are often used to decide what additional testing should be done or how to stratify if the patient you need to be admitted to the hospital.

“While there may be some unconscious bias, maybe what [clinicians in the emergency department] what they were doing was really consistent with the overall risk of the people in that population, ”he speculated.

“The real question,” Yang said, “is, is the delay in attention or the reduction in the amount of testing impacting the outcome?” If not, maybe the attention was adequate. However, this study did not have this information.

“Even among hospitalized patients, the likelihood that most of them would have a heart attack is very low,” Yang also noted.

From sorting to entry (possible)

MI is the leading cause of death in women and is rising among young adults, Banco said. A previous study reported that in 2013, approximately one-third of hospitalized patients with acute MI were between the ages of 35 and 54, it noted.

Other studies reported that, compared to men, women with MI were less likely to recognize their chest pain as heart disease, and compared to young men, young women had more delays in care, worse physical and mental health afterwards, a lower probability of returning to work in the next twelve months and a higher mortality.

To investigate possible sexual differences in the assessment and management of young patients with chest pain, from triage to the emergency department to admission (potential), Banco and colleagues analyzed data from the Outpatient medical care survey of the National Hospital of Centers for Disease Control and Prevention, which provides a nationally representative sample.

They identified 4,152 records of emergency department visits by people aged 18 to 55 with chest pain in 2014 to 2018.

Patients had a mean age of 38 years and just over half (57%) were women.

A similar percentage of men and women arrived by ambulance (17%).

Women were less likely than men to be chosen as emergent (potentially life-threatening) or urgent (requiring emergency intervention; 57% vs. 63%) and women also expected more time to see a provider. (45 vs. 37 minutes; Pg <.001 for both).

A similar percentage of women and men performed cardiac enzyme testing (approximately 21%).

However, women were less likely than men to receive an ECG (74.0% vs 79.0%), to undergo heart control (25.0% vs 30.0%), to be consulted by a consultant (8.5% vs. 12.0%) or to be admitted to hospital. or to an observation unit (12.0% vs 18.0%; Pg <.05 for all).

Scientific session of the American College of Cardiology (ACC) 2021.

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