Women at a disadvantage in care, outcomes for acute chest pain: study

Mortality for ST-segment elevation myocardial infarction (STEMI) is higher for women, but they tend to have better outcomes for other aetiologies of chest pain compared with men, a study has shown.

This state-wide population-based cohort study assessed sex differences in epidemiology and care pathways from emergency medical services (EMS) contact through to clinical outcomes following discharge. The investigators included consecutive adult patients attended by EMS for acute undifferentiated chest pain in Victoria, Australia, from 1 January 2015 to 30 June 2019.

Individual EMS clinical data were linked to emergency and hospital administrative datasets. Multivariable analyses were conducted to evaluate mortality data and differences in care quality and outcomes.

Of the 256,901 EMS attendances for chest pain, half (n=129,096, 50.3 percent) were women (mean age 61.6 years). Compared with men, women had marginally higher age-standardized incidence rates (1,191 vs 1,135 per 100,000 person-years).

Multivariate analysis revealed that women were less likely to receive guideline-directed care across most care measures, such as transport to hospital, prehospital aspirin or analgesia administration, 12-lead electrocardiogram, intravenous cannula insertion, and off-load from EMS or review by emergency department clinicians within target times.

Women with acute coronary syndrome were also less likely to undergo angiography or be admitted to a cardiac or intensive care unit. In addition, women diagnosed with STEMI had higher 30-day and long-term mortality, but lower overall.

“Substantial differences in care are present across the spectrum of acute chest pain management from first contact through to hospital discharge,” the investigators said.