Abstract 2092: Gender and Symptom Differences in Acute Coronary Syndromes
Introduction- Nearly 900,000 Americans were discharged from the hospital with acute coronary syndromes (ACS) in 2003. While recent large scale gender specific trials have shed valuable light on presentation, diagnosis, and outcomes in women with heart disease, there have been few studies examining gender differences in presentation in the same cohort of patients. Therefore, the purpose of this study was to examine gender and symptom differences in patients with unstable angina, non-ST elevation MI, and ST-elevation MI (ACS).
Methods-Participants included 112 women and 144 men presenting to the emergency department and hospitalized for ACS. Recruitment took place at two urban tertiary care centers in the Midwest. The type, severity, location, and quality of symptoms were assessed during interviews in the patient’s hospital room. Demographic characteristics, health history, functional status, anxiety, and depression levels were also measured.
Results- Women were significantly older (67.1 vs. 62.3 years, p<.01), less likely to be married (39% vs. 64%, p<.01), and more likely to have an income under $20,000 annually (43% vs. 25%, p=.02). There were significant gender effects for eight of the 20 symptoms assessed. Women reported significantly more indigestion (p=.039), palpitations (p=.015), nausea (p=.008), numbness in the hands (p=.034), and unusual fatigue (p<.001) that did not differ by diagnosis. The gender effect for dizziness, weakness, and cough did differ by diagnosis. Women with unstable angina and NSTEMI were more likely to report weakness (p=.006 & p=.028). Women with NSTEMI reported more new coughing (p=.001). Men with STEMI were more likely to experience dizziness (p< .001). Of note, unusual fatigue was the second most frequently reported symptom (61.2%) after chest pain for both sexes. Chest pain was absent in 15% of patients.
Conclusions- Women reported a higher incidence of seven symptoms during an episode of ACS. Only one, unusual fatigue, was frequently reported and would be unlikely to prompt patients to seek emergent care unless it occurred in conjunction with chest pain. Targeted interventions to enhance symptom recognition may help inform patients and providers of the gender and symptom differences identified in this study.