What is it about?

This study looked at 199 men and 246 women presenting to the emergency department with acute, nontraumatic chest pain and found significant differences between men and women. The time to first contact with a physician was 17.3 minutes for women and 13.2 minutes for men. 92% of men had their initial EKG within 30 minutes but only 83% of women did.

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Why is it important?

This abstract presented in 1991 is perhaps the earliest documentation of gender bias in evaluating acute nontraumatic chest pain in the emergency department. - It suggests there may be gender disparities in the promptness of care received in the emergency department for patients presenting with chest pain. Chest pain can be a symptom of serious cardiovascular conditions like heart attack, so delays in diagnosis and treatment could negatively impact outcomes. - The differences found in time to first physician contact and time to EKG for men and women were statistically significant. This lends credibility to the idea that the disparities were real and not just due to chance. - Chest pain is a common reason for emergency department visits, so these disparities have the potential to impact many patients. - Identifying disparities is an important first step toward addressing them. The results of this study could help prompt further research into why these gaps exist and how to ensure more equitable cardiovascular care between genders. - Equitable preventive care and prompt emergency care for cardiovascular disease improve outcomes for all groups. Understanding where disparities exist is valuable for improving the quality of care and public health overall. In summary, the study provides evidence that there may be gender-based differences in the rapidity of emergency cardiac care, which can influence patient outcomes. The findings highlight the need to ensure prompt diagnosis and treatment for all groups with this common presentation.

Perspectives

I believe these findings highlight an important healthcare disparity that warrants further investigation. Our results suggest that a gender gaps exists in the timeliness of care for patients with chest pain. From my perspective as a physician, these differences are concerning. Those initial minutes after a patient with potential cardiac issues arrives can be crucial. Any delays in EKG testing or contact with physicians could impact our ability to diagnose and treat conditions like heart attacks. Our team was surprised that women were waiting longer and receiving EKGs less quickly. More research is needed to understand what factors might be contributing here. Are there differences in how men and women report or describe chest pain that influence triaging? Are there unconscious biases among staff that delay workups for women? Or are there other logistical factors at play? We can address these disparities head-on by getting to the root of what causes them. Our goal is for every patient walking through our doors to receive the prompt emergency cardiac care they need, regardless of gender or other factors. This study shows we still have progress to make toward that goal. I'm hopeful our findings will spur improved practices in emergency departments everywhere.

Thomas F Heston MD
University of Washington

Read the Original

This page is a summary of: GENDER-SPECIFIC DIFFERENCES IN THE EVALUATION AND MANAGEMENT OF CHEST PAIN, Southern Medical Journal, September 1991, Southern Medical Association,
DOI: 10.1097/00007611-199109001-00078.
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