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Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study
OBJECTIVES: Prompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS. DESIGN: Data were collected within a p...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855399/ https://www.ncbi.nlm.nih.gov/pubmed/29476027 http://dx.doi.org/10.1136/bmjopen-2017-018798 |
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author | Araújo, Carla Laszczyńska, Olga Viana, Marta Melão, Filipa Henriques, Ana Borges, Andreia Severo, Milton Maciel, Maria Júlia Moreira, Ilídio Azevedo, Ana |
author_facet | Araújo, Carla Laszczyńska, Olga Viana, Marta Melão, Filipa Henriques, Ana Borges, Andreia Severo, Milton Maciel, Maria Júlia Moreira, Ilídio Azevedo, Ana |
author_sort | Araújo, Carla |
collection | PubMed |
description | OBJECTIVES: Prompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS. DESIGN: Data were collected within a prospective cohort study (EPIHeart). SETTING: Patients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014. PARTICIPANTS: Presenting symptoms of 873 patients (227 women) were obtained through a face-to-face interview. Outcome measures: Typical pain was defined according to the definition of cardiology societies. Clusters of symptoms other than pain were identified by latent class analysis. Logistic regression was used to quantify differences in presentation of ACS symptoms by sex. RESULTS: Chest pain was reported by 82% of patients, with no differences in frequency or location between sexes. Women were more likely to feel pain with an intensity higher than 8/10 and this association was stronger for patients aged under 65 years (interaction P=0.028). Referred pain was also more likely in women, particularly pain referred to typical and atypical locations simultaneously. The multiple symptoms cluster, which was characterised by a high probability of presenting with all symptoms, was almost fourfold more prevalent in women (3.92, 95% CI 2.21 to 6.98). Presentation with this cluster was associated with a higher 30-day mortality rate adjusted for the GRACE V.2.0 risk score (4.9% vs 0.9% for the two other clusters, P<0.001). CONCLUSIONS: While there are no significant differences in the frequency or location of pain between sexes, women are more likely to feel pain of higher intensity and to present with referred pain and symptoms other than pain. Knowledge of these ACS presentation profiles is important for health policy decisions and clinical practice. |
format | Online Article Text |
id | pubmed-5855399 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-58553992018-03-19 Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study Araújo, Carla Laszczyńska, Olga Viana, Marta Melão, Filipa Henriques, Ana Borges, Andreia Severo, Milton Maciel, Maria Júlia Moreira, Ilídio Azevedo, Ana BMJ Open Cardiovascular Medicine OBJECTIVES: Prompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS. DESIGN: Data were collected within a prospective cohort study (EPIHeart). SETTING: Patients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014. PARTICIPANTS: Presenting symptoms of 873 patients (227 women) were obtained through a face-to-face interview. Outcome measures: Typical pain was defined according to the definition of cardiology societies. Clusters of symptoms other than pain were identified by latent class analysis. Logistic regression was used to quantify differences in presentation of ACS symptoms by sex. RESULTS: Chest pain was reported by 82% of patients, with no differences in frequency or location between sexes. Women were more likely to feel pain with an intensity higher than 8/10 and this association was stronger for patients aged under 65 years (interaction P=0.028). Referred pain was also more likely in women, particularly pain referred to typical and atypical locations simultaneously. The multiple symptoms cluster, which was characterised by a high probability of presenting with all symptoms, was almost fourfold more prevalent in women (3.92, 95% CI 2.21 to 6.98). Presentation with this cluster was associated with a higher 30-day mortality rate adjusted for the GRACE V.2.0 risk score (4.9% vs 0.9% for the two other clusters, P<0.001). CONCLUSIONS: While there are no significant differences in the frequency or location of pain between sexes, women are more likely to feel pain of higher intensity and to present with referred pain and symptoms other than pain. Knowledge of these ACS presentation profiles is important for health policy decisions and clinical practice. BMJ Publishing Group 2018-02-23 /pmc/articles/PMC5855399/ /pubmed/29476027 http://dx.doi.org/10.1136/bmjopen-2017-018798 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Cardiovascular Medicine Araújo, Carla Laszczyńska, Olga Viana, Marta Melão, Filipa Henriques, Ana Borges, Andreia Severo, Milton Maciel, Maria Júlia Moreira, Ilídio Azevedo, Ana Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study |
title | Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study |
title_full | Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study |
title_fullStr | Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study |
title_full_unstemmed | Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study |
title_short | Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study |
title_sort | sex differences in presenting symptoms of acute coronary syndrome: the epiheart cohort study |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855399/ https://www.ncbi.nlm.nih.gov/pubmed/29476027 http://dx.doi.org/10.1136/bmjopen-2017-018798 |
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