Sex differences in acute chest pain care in a multisite U.S. emergency department cohort

BACKGROUND: Large studies examining sex-based differences in emergency department (ED) cardiovascular care are lacking. This analysis compared cardiovascular healthcare utilization and safety outcomes between women and men in a large U.S. cohort managed under a standardized high-sensitivity troponin (hs-cTn) pathway. METHODS: We conducted an observational study of ED patients ≥18 years old presenting with chest pain from 1/2021-12/2021 across 25 EDs. Sex was defined by the legal sex EHR variable. The primary safety outcome was 30-day all-cause death or myocardial infarction (MI). The primary healthcare utilization outcome was hospitalizations at 30 days. Secondary healthcare utilization outcomes included 30-day objective cardiac testing (OCT: stress testing, coronary computed tomography angiography, invasive coronary angiography). Outcomes were compared between sexes using chi-squared tests and logistic regression, where models adjusted for cardiovascular disease confounders and initial hs-cTn. RESULTS: Among 40,979 patients, 56.6% (23,188/40,979) were female with mean age 52. Death or MI at 30 days occurred in 2.4% (552/23,188) of women and 5.2% (917/17,791) of men (p < 0.001). After adjustment, women had lower odds of death or MI (aOR 0.65, 95% CI 0.57-0.74). Hospitalizations occurred in 30.2% (6998/23,188) of women compared to 36.0% (6411/17,791) of men (p < 0.001). OCT occurred in 14.9% (3452/23,188) of women and 19.6% (3488/17,791) of men (p < 0.001). With adjustment, women were hospitalized less (aOR 0.93, 95% CI 0.88-0.98) and underwent less OCT (aOR 0.93, 95% CI 0.87-0.98) at 30-days. CONCLUSION: In a large ED cohort of patients with chest pain, rates of death or MI, hospitalizations, and OCT at 30-days were lower in women compared to men.