Variables
Socio-demographic variables
Past medical , surgical history , and family history
TABLE 1 . Recorded variables Components collected
Age , sex , race , body mass index , waist circumference , ability to exercise , alcohol , tobacco , illicit substance abuse
Coronary artery disease ( CAD ), hypertension , hyperlipidemia , diabetes mellitus type-2 , last menstrual period , pregnancy , hysterectomy , oral contraceptive pill use , family history of CAD
Symptoms Location of chest pain , reproducible musculoskeletal pain , radiation of pain , nausea , and vomiting , exacerbating and relieving factors , diaphoresis , dyspnea , dizziness , heartburn
Vitals Examination Medication list
Temperature , pulse rate , respiratory rate , blood pressure , oxygen saturation Jugular venous distention , cardiovascular , respiratory , abdominal examination
Aspirin , nitroglycerin , analgesic , OTC medicines , antihypertensive medications , cholesterollowering meds , diabetes meds , gastrointestinal meds , pulmonary meds , neuro-psych meds ( antidepressants , anxiolytics , mood-stabilizing anti-epileptics , lithium , antipsychotics ), oral anticoagulation meds , steroids , hormones , other meds )
Laboratory data Total cholesterol , low density lipoprotein , high density lipoprotein , triglycerides , troponin , creatinine kinase , D-dimer
Electrophysiological studies Radiological studies Others
Electrocardiogram ( ECG ) and echocardiography ( ECHO ) findings , number of ECG and ECHO Chest radiograph , computerized tomography , magnetic resonance imaging
Cardiac catheterization , number of catheterizations , admission status , medication received after the admission , type of services consulted , number of days admitted , discharge diagnosis , returned to ED within 30 days , treating physician gender
There was a statistically significant difference between chest pain and body mass index ( overweight and obesity ) irrespective of gender . Several risk factors that were assessed retrospectively and did not have a statistical difference were tobacco , alcohol use , substance use , and family history . There was no statistical difference in preexisting medical conditions between the genders including hypertension , hypercholesterolemia / hyperlipidemia , or coronary artery disease .
Forty-four women ( 22 %) were more likely to be on hormonal supplementation ( oral contraceptive and hormonal replacement therapy ) compared to 3 men ( 2 %) ( p < 0.05 ). Of these 44 women , 12 ( 7 %) were on oral contraceptives versus 32 ( 16 %) who were on hormonal replacement therapy . There were more women compared to men on pulmonary medications , p < 0.5 ( Table 3 ).
On physical examination , women were more likely to have a statistically significant difference in pulse > 100 bpm compared to men ( 34 % vs 25 %). There was no significant difference between the sexes in blood pressure , temperature , respiratory rate , examination of the cardiovascular system , respiratory system , gastrointestinal examinations , or presence of altered mental status . Electrocardiography was performed in 170 men ( 95 %) and 176 women ( 90 %), with 29 ( 8 %) not receiving an electrocardiogram . No statistically significant difference between women and men in wait-time for receiving an electrocardiogram , having an abnormal electrocardiogram ( for example ST elevation ), and reception of cardiac monitoring were found . There was no statistically significant difference between the genders in the presence of left bundle branch block , third-degree atrioventricular block , atrial dysrhythmia , or ventricular dysrhythmia . Lack of statistically significant differences between the genders were found in how often complete blood count , complete chemical profile , lactate dehydrogenase isoenzymes , creatine kinase-MB peak flow measurement , arterial blood gases , d-dimer , or chest x-rays were obtained or in the incidence of abnormal results . This cohort demonstrated that 33 women ( 17 %) received more gastrointestinal medications like histamine 2 ( H2 ) blockers , antacids , and proton pump inhibitors when compared to 19 men ( 11 %), a statistically significant finding for gender bias . Fifty- eight ( 30 %) women and 53 men ( 30 %) received nonsteroidal anti-inflammatory drugs ( NSAIDs ), but women were more likely to be prescribed over-the-counter ( OTC ) medications ( 28 women , or 12 %, versus 12 men , or 7 %) ( p < 0.05 ).
In the ED , 13 men ( 7 %) and 15 women ( 8 %) received a cardiology consultation , and 10 men ( 6 %) and six women ( 3 %) were admitted to the floor from the ED , and the difference was not statically significant . In comparison , the 1996 study found that men were consistently tested more aggressively than women . Seventeen women ( 13 %) received nitroglycerin compared to 13 men ( 7 %), and this difference was statistically significant .
In this cohort , no statistically significant differences were noted for thrombolytics — four men ( 4 %) versus seven women ( 5 %) and emergency catheterization — one-man ( 0.5 %) versus two women ( 1 %). Eight ( 4 %) women and 11 ( 6 %) men received the diagnosis of myocardial infarction . A slightly greater number of 93 women ( 47 %) compared to 83 men ( 46 %) were discharged from ED , and the difference was not statistically significant ( Table 4 ).
West Virginia Medical Journal • June 2021 • 21