Paper
Thursday, July 14, 2005
A Gender Comparison of Symptoms and Complications of ACS to Length of Delay in Seeking Treatment
Candace C. Cherrington, PhD, RN, Miami Valley College of Nursing & Health, Wright State Univeristy, Dayton, OH, USA, Debra K. Moser, DNSc, RN, College of Nursing, University of Kentucky, Lexington, KY, USA, and Kyungeh An, PhD, Research Institute of Nursing Science, Seoul National University, Seoul, Korea, South Korea.
| Learning Objective #1: Describe differences in ACS symptoms between men and women |
| Learning Objective #2: Describe the importance of determining significant predictors of morbidity and mortality in ACS |
Although the data are inconsistent, it is commonly believed that women delay longer than men in seeking treatment for acute coronary syndrome (ACS) symptoms. Longer delay times are thought to contribute to the increased morbidity and mortality among women with ACS. In this secondary analysis we studied an equal number of men (n=131, 50.6%) and women (n=128, 49.4%) with ACS and tested the relationship between delay, gender and the incidence of in-hospital complications. Hierarchical multiple regression analysis of the relationship between gender and delay time and hierarchical logistic regression analysis of the relationship between gender delay time and the likelihood of complications were conducted. Controlling for demographic and clinical variables, there were no significant relationships between gender and length of delay (adjusted Rsquare-0.42, F change.648, p.42) and the likelihood of complications (model chi-square24.707, p.13). Only left ventricular ejection fraction was a significant predictor of complications (B.05. Wald 0.28, p.001, Exp(B).95). Women experienced significantly more symptoms (average 2.1) then men (t-.582, p=.013). Fisher's Exact test (2-tailed) of the differences in the proportion of men and women experiencing specific symptoms demonstrated that women experienced significantly more dizziness (p=.04), irritability (p=.038), and upset stomach (p=.005) then men. There were no significant differences in the proportion of men and women experiencing fatigue, nausea, breathlessness, headache, loss of strength, irregular heart beat, muscle cramps, flu-like symptoms, increased perspiration, numbness and coughing. These findings suggest that the long touted belief that women delay longer than men and that this is a major reason for their greater morbidity and mortality may in fact be in error. There is a need to examine further the relationship between gender and length of delay in seeking treatment for the ACS and a deeper investigation of the gender differences in symptoms to develop interventions to decrease morbidity and mortality.