Sex Differences in Evaluation and Outcome of Unstable Angina
CONTEXT The existence of sex bias in the delivery of cardiac care is controversial, and little is known about the association between sex and delivery of care and outcomes at an early point in the diagnostic sequence, such as when patients present for the evaluation of chest pain. OBJECTIVE To test...
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Published in | JAMA : the journal of the American Medical Association Vol. 283; no. 5; pp. 646 - 652 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Chicago, IL
American Medical Association
02.02.2000
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Subjects | |
Online Access | Get full text |
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Summary: | CONTEXT The existence of sex bias in the delivery of cardiac care is controversial,
and little is known about the association between sex and delivery of care
and outcomes at an early point in the diagnostic sequence, such as when patients
present for the evaluation of chest pain. OBJECTIVE To test the hypothesis that female sex is negatively associated with
care delivered to and outcomes of persons diagnosed as having unstable angina. DESIGN Inception population-based cohort study with an average of 6 years of
follow-up. SETTING Emergency departments (EDs) in Olmsted County, Minnesota. PATIENTS A total of 2271 Olmsted County residents (1306 men and 965 women) who
presented to the ED for the first time with symptoms meeting criteria for
unstable angina between 1985 and 1992. MAIN OUTCOME MEASURES Use of cardiac procedures within 90 days of ED visit, overall mortality,
and cardiac events (cardiac death, nonfatal myocardial infarction, nonfatal
cardiac arrest, and congestive heart failure), compared by sex and Agency
for Health Care Policy and Research cardiovascular risk category (low, intermediate,
or high). RESULTS Women were older (P<.001), more likely to
have a history of hypertension (P = .001), and less
likely to present with typical angina (P = .004)
than men. Men were more likely than women to undergo noninvasive cardiac tests
(relative risk [RR], 1.27; 95% confidence interval [CI], 1.14-1.40) as well
as invasive cardiac procedures (RR, 1.72; 95% CI, 1.51-1.97). After adjustment,
male sex was associated with a 24% increase in the use of cardiac procedures.
Survival of both men and women in the high and intermediate risk categories
was significantly lower than expected per the general population (P<.001). Women had a worse outcome than men, but after multivariate
adjustment, male sex was associated with a trend toward an increase in the
risk of death (RR, 1.23; 95% CI, 0.99-1.54) and significantly associated with
increased risk of cardiac events (RR, 1.21; 95% CI, 1.03-1.42). CONCLUSIONS Our population-based data indicate that after an ED visit for symptoms
of unstable angina, the use of cardiac procedures was lower in women, but
after taking into account baseline characteristics, men experienced worse
outcomes. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0098-7484 1538-3598 |
DOI: | 10.1001/jama.283.5.646 |