Sex Differences in Symptoms Across the Continuum of Acute Coronary Syndromes

Thursday, 10 July 2008: 1:15 PM
Holli A. DeVon, PhD, RN , Niehoff School of Nursing, Loyola University Chicago, Maywood, IL
Amy L. Ochs, MSN , Niehoff School of Nursing, Loyola University Chicago, Maywood, IL

Learning Objective 1: identify sex differences and similarities in the symptoms of acute coronary syndromes.

Learning Objective 2: to identify the characteristics of women with acute coronary syndromes that make them more vulnerable to poorer outcomes compared to men.

Background- Determination of sex and symptom differences in acute coronary syndromes (ACS) is important since the urgency and level of care provided partially depends upon clinical presentation. Most studies addressing sex differences in the symptoms of ACS collected symptom data secondary to an examination of prehospital delay times and treatment outcomes or abstracted data from records.

Purpose- The purpose of this study was to identify sex differences in the type, severity, location, and quality of symptoms across the three clinical diagnostic categories of ACS (unstable angina, non-ST elevation myocardial infarction, and ST elevation myocardial infarction) while controlling for age, diabetes, functional status, anxiety, and depression.

Methods- A convenience sample of 112 women and 144 men admitted through the emergency department and hospitalized for acute coronary syndromes participated. Recruitment took place at two urban teaching hospitals in the Midwest. Data were collected during structured interviews in the patient's hospital room. Demographic characteristics, health history, functional status, anxiety, and depressions 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/ year (43% vs. 25%). Women reported significantly more indigestion (beta=0.25; CI=0.01-0.49), palpitations (beta=0.31; CI=0.06-0.56), nausea (beta=0.37; CI=0.10-0.65), numbness in the hands (beta=0.29; CI=0.02-0.57), and unusual fatigue (beta=0.60; CI=0.27-0.93) that did not differ across diagnosis. Sex differences in dizziness, weakness, and new onset cough did differ by diagnosis. There were no differences between women and men in reports of chest pain.

Conclusions- Women reported a higher intensity of five symptoms during an episode of ACS. Significant sex differences were not found in the key symptom of chest pain. Whether differences in less typical symptoms are clinically significant remains unclear.