Advertisement

 

 

Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study.

Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study.
Author Information (click to view)

Araújo C, Laszczyńska O, Viana M, Melão F, Henriques A, Borges A, Severo M, Maciel MJ, Moreira I, Azevedo A,


Araújo C, Laszczyńska O, Viana M, Melão F, Henriques A, Borges A, Severo M, Maciel MJ, Moreira I, Azevedo A, (click to view)

Araújo C, Laszczyńska O, Viana M, Melão F, Henriques A, Borges A, Severo M, Maciel MJ, Moreira I, Azevedo A,

Advertisement

BMJ open 2018 02 238(2) e018798 doi 10.1136/bmjopen-2017-018798
Abstract
OBJECTIVES
Prompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS.

DESIGN
Data were collected within a prospective cohort study (EPIHeart).

SETTING
Patients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014.

PARTICIPANTS
Presenting symptoms of 873 patients (227 women) were obtained through a face-to-face interview.

OUTCOME MEASURES
Typical pain was defined according to the definition of cardiology societies. Clusters of symptoms other than pain were identified by latent class analysis. Logistic regression was used to quantify differences in presentation of ACS symptoms by sex.

RESULTS
Chest pain was reported by 82% of patients, with no differences in frequency or location between sexes. Women were more likely to feel pain with an intensity higher than 8/10 and this association was stronger for patients aged under 65 years (interaction P=0.028). Referred pain was also more likely in women, particularly pain referred to typical and atypical locations simultaneously. The multiple symptoms cluster, which was characterised by a high probability of presenting with all symptoms, was almost fourfold more prevalent in women (3.92, 95% CI 2.21 to 6.98). Presentation with this cluster was associated with a higher 30-day mortality rate adjusted for the GRACE V.2.0 risk score (4.9% vs 0.9% for the two other clusters, P<0.001). CONCLUSIONS
While there are no significant differences in the frequency or location of pain between sexes, women are more likely to feel pain of higher intensity and to present with referred pain and symptoms other than pain. Knowledge of these ACS presentation profiles is important for health policy decisions and clinical practice.

Submit a Comment

Your email address will not be published. Required fields are marked *

18 + twenty =

[ HIDE/SHOW ]