Are there gender disparities in symptom presentation or triage of patients with chest discomfort at primary care out-of-hours services? An observational study

• Published in: BMJ open Vol. 9; no. 11; p. e031613
• Main Authors: van der Meer, Manon G., Appelman, Yolande, Rutten, Karlijn H.G., van der Graaf, Yolanda, Nathoe, Hendrik M., Doevendans, Pieter A., Smit, Michelle, Verheij, Emmy, Botermans, Anne, Rutten, Frans H.
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 19.11.2019; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: acute coronary syndrome; Acute coronary syndromes; Bias; Cardiovascular disease; chest pain; Decision trees; Emergency medical care; Family medical history; gender; Gender differences; General practice / Family practice; Heart attacks; Observational studies; Pain; Patients; Primary care; primary care out-of-hours service; triage; Women; Netherlands; primary care out-of-hours service; acute coronary syndrome; gender; chest pain; triage
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-031613

ObjectivesPrevious 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.DesignRetrospective observational study.SettingPrimary care OHS.Participants276 women and 242 men with chest discomfort who contacted a primary care OHS in the Netherlands in 2013 and 2014.Main outcome measuresDifferences between women and men regarding symptom presentation and urgency allocation.Results8.4% 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.ConclusionsDiscriminating 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.