Gender Bias in Chest Pain Evaluation in the Emergency Department: A 25-Year Update

Abstract

INTRODUCTION Due to having atypical presentations, women with potential cardiac disease may be approached and treated less aggressively than male patients. Differences in care along gender lines have been described at a university affiliated hospital in West Virginia (WV) in the past three decades. The purpose of this study is to determine if differences along gender lines in the care of patients with chest pain persists. METHODS From July-December of 2015, a retrospective chart review was performed at Cabell Huntington Hospital in WV. Data from 375 patients with a diagnosis of chest pain presenting to the emergency department (ED) was compared to data from 25 years prior. Symptoms, risk factors, medical history, medications, physical examination, laboratory, and electrocardiogram results, treatment in the emergency department, and ultimate diagnoses were studied. RESULTS Women had less reproducible musculoskeletal pain and more use of over-the-counter medicines, hormones, and pulmonary medications before presenting to the ED. Treatment with nitroglycerin and gastrointestinal medications occurred more commonly in women. Regarding evaluations of symptoms, women received more electrocardiograms, cardiac monitoring, and laboratory testing in comparison to 25 years prior. Cardiology consultations and emergency catheterization as well as the use of aspirin, heparin, antibiotics, anxiolytics, and thrombolytic agents were more commonly used in the treatment of women in comparison to 25 years prior. CONCLUSIONS In comparison to 25 years prior, there were documented improvements in the management of women presenting to the ED and experiencing new-onset, non-traumatic chest pain.