Disclosures: The authors report no relevant financial disclosures.
May 29, 2020
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ACS presentation may differ in women vs. men

Disclosures: The authors report no relevant financial disclosures.
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Women with ACS were more likely to present with nausea or vomiting, pain between the shoulder blades and shortness of breath compared with men, according to a systematic review published in the Journal of the American Heart Association.

Researchers also observed some overlap in symptoms of ACS between men and women, according to the study.

Sanne A.E. Peters

“Delayed symptom recognition by either patients or medical professionals is a key reason for delay in potentially lifesaving treatment,” Sanne A.E. Peters, PhD, research fellow in epidemiology at The George Institute for Global Health at the University of Oxford in the United Kingdom and associate professor at the University Medical Center Utrecht in the Netherlands, said in a press release. “By shedding further light on sex differences in clinical presentation with ACS, this research will hopefully lead to more timely and equitable treatment and outcomes.”

Roos E.M. van Oosterhout, BSc, of the Julius Center for Health Sciences and Primary Care at University Medical Center Utrecht, and colleagues analyzed data 1,226,163 patients from 27 studies that assessed symptom presentation in men and women with confirmed ACS, defined as unstable angina or MI. Mean age ranged from 47 to 69 years in men and from 47 to 78 years in women.

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Odds ratios for ACS symptoms including nausea, vomiting, pain between shoulder blades and shortness of breath among women compared with men.

Women with ACS were more likely to present with nausea or vomiting (OR = 1.64; 95% CI, 1.48-1.82; I2 = 52%), pain between the shoulder blades (OR = 2.15; 95% CI, 1.95-2.37; I2 = 0%) and shortness of breath (OR = 1.34; 95% CI, 1.21-1.48; I2 = 63%) compared with men. In contrast, women were less likely to present with diaphoresis (OR = 0.84; 95% CI, 0.76-0.94; I2 = 59%) and chest pain (OR = 0.7; 95% CI, 0.63-0.78; I2 = 84.5%).

Researchers observed some overlap in the prevalence of some symptoms between both sexes. Men and women most often presented with chest pain (pooled prevalence, 79% vs. 74%, respectively), shortness of breath (pooled prevalence, 40% vs. 48%, respectively), diaphoresis (pooled prevalence, 47% vs. 44%, respectively), nausea or vomiting (pooled prevalence, 28% vs. 39%, respectively) and left arm and left shoulder pain (pooled prevalence, 37% vs. 38%, respectively).

Evidence established the presence of sex differences regarding symptom presentation since the early 2000s. Cumulative findings did not materially change with findings from newer studies.

“This review shows that sex differences in symptoms among patients with confirmed ACS have been established in the literature for more than a decade,” van Oosterhout and colleagues wrote. “To address the remaining uncertainties, such as how sex differences in symptom presentation may differ by age or other patient characteristics, future research should focus on standardized data collection and reporting.”

Disclosures: The authors report no relevant financial disclosures.