The following is a summary of “Sex-disparities in chest pain workup: a retrospective cohort review of a university based clinical decision pathway,” published in the December 2023 issue of Cardiology by Titus et al.
Researchers conducted a retrospective study in the emergency departments (ED) to explore if clinical decision pathways (CDPs) and the HEART score could reduce sex disparities in chest pain workup and risk stratification.
They performed a retrospective cohort review of adult ED encounters for chest pain where a CDP was utilized. The primary outcome was the occurrence of non-invasive imaging (coronary CTA, stress imaging), invasive testing, intervention (PCI or CABG), or death. Secondary outcomes included 30-day major adverse cardiac events (MACE). HEART scores and primary/secondary outcomes were stratified by sex.
The results showed 1,078 charts, with a mean age at presentation of 59 years. Females comprised 47% of the population. Among the population, 17%, 65%, and 18% were categorized as low, intermediate, and high-risk based on the HEART score, respectively, with no significant changes between genders. Non-invasive testing was the same between males and females when stratified by risk. High-risk males underwent more coronary angiograms (33% vs. 16%, P=0.01) and PCI (18% vs. 8%, P=0.04) compared to high-risk females, but no such differences were observed in patients categorized as low or intermediate risk. Males experienced a higher incidence of MACE than females (8% vs. 3%, P=0.001).
They concluded that ED CDPs minimized sex bias in chest pain assessment, but high-risk males got more invasive procedures and had worse outcomes, the cause is unclear and needs more research.
Source: bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-023-03610-3
