TY - JOUR
T1 - Are there gender disparities in symptom presentation or triage of patients with chest discomfort at primary care out-of-hours services? An observational study
AU - van der Meer, Manon G.
AU - Appelman, Yolande
AU - Rutten, Karlijn H. G.
AU - van der Graaf, Yolanda
AU - Nathoe, Hendrik M.
AU - Doevendans, Pieter A.
AU - Smit, Michelle
AU - Verheij, Emmy
AU - Botermans, Anne
AU - Rutten, Frans H.
PY - 2019
Y1 - 2019
N2 - Objectives Previous hospital-based studies have suggested delayed recognition of acute coronary syndrome (ACS) in women. We wanted to assess differences in symptom presentation or triage among women and men who contacted primary care out-of-hours services (OHS) for chest discomfort. Design Retrospective observational study. Setting Primary care OHS. Participants 276 women and 242 men with chest discomfort who contacted a primary care OHS in the Netherlands in 2013 and 2014. Main outcome measures Differences between women and men regarding symptom presentation and urgency allocation. Results 8.4% women and 14.0% men had ACS. Differences in symptoms between patients with and without ACS were in general small, for both women and men. In women with ACS compared with women without ACS, mean duration of telephone calls was discriminative; 5.22 (SD 2.53) vs 7.26 (SD 3.11) min, p value=0.003. In men, radiation of pain (89.3% vs 54.9%, p value=0.011) was discriminative for ACS, and stabbing chest pain (3.7% vs 24.0%, p value=0.014) for absence of ACS. Women and men with chest discomfort received similar high urgency allocation (crude and adjusted OR after correction for ACS and age; 1.03 (95% CI 0.72 to 1.48) and 1.04 (95% CI 0.72 to 1.52), respectively). Women with ACS received a high urgency allocation in 22/23 (95.7%) and men with ACS in 30/34 (88.2%), p value=0.331. Conclusions Discriminating ACS in patients with chest discomfort who contacted primary care OHS is difficult in both women and men. Women and men with chest discomfort received similar high urgency allocation.
AB - Objectives Previous hospital-based studies have suggested delayed recognition of acute coronary syndrome (ACS) in women. We wanted to assess differences in symptom presentation or triage among women and men who contacted primary care out-of-hours services (OHS) for chest discomfort. Design Retrospective observational study. Setting Primary care OHS. Participants 276 women and 242 men with chest discomfort who contacted a primary care OHS in the Netherlands in 2013 and 2014. Main outcome measures Differences between women and men regarding symptom presentation and urgency allocation. Results 8.4% women and 14.0% men had ACS. Differences in symptoms between patients with and without ACS were in general small, for both women and men. In women with ACS compared with women without ACS, mean duration of telephone calls was discriminative; 5.22 (SD 2.53) vs 7.26 (SD 3.11) min, p value=0.003. In men, radiation of pain (89.3% vs 54.9%, p value=0.011) was discriminative for ACS, and stabbing chest pain (3.7% vs 24.0%, p value=0.014) for absence of ACS. Women and men with chest discomfort received similar high urgency allocation (crude and adjusted OR after correction for ACS and age; 1.03 (95% CI 0.72 to 1.48) and 1.04 (95% CI 0.72 to 1.52), respectively). Women with ACS received a high urgency allocation in 22/23 (95.7%) and men with ACS in 30/34 (88.2%), p value=0.331. Conclusions Discriminating ACS in patients with chest discomfort who contacted primary care OHS is difficult in both women and men. Women and men with chest discomfort received similar high urgency allocation.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85075325383&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31748303
U2 - https://doi.org/10.1136/bmjopen-2019-031613
DO - https://doi.org/10.1136/bmjopen-2019-031613
M3 - Article
C2 - 31748303
SN - 2044-6055
VL - 9
JO - BMJ Open
JF - BMJ Open
IS - 11
M1 - e031613
ER -