Sex Differences Noted in Presentation, Diagnosis of Chest Pain in Primary Care
By Laurie Barclay, MD
Medscape Medical News
January 5, 2010 — There are sex differences in presentation and diagnosis of chest pain in primary care, according to the results of a study reported online in the December 14, 2009, issue of BMC Family Practice.
"Chest pain is a common complaint and reason for consultation in primary care," write Stefan Bosner, MD, MPH, from the University of Marburg in Marburg, Germany, and colleagues. "Research related to gender differences in regard to Coronary Heart Disease (CHD) has been mainly conducted in hospital but not in primary care settings. We aimed to analyse gender differences in aetiology and clinical characteristics of chest pain and to provide gender related symptoms and signs associated with CHD."
The study sample consisted of 1212 consecutive patients 35 years and older with chest pain seen at offices of 74 general practitioners, who recorded symptoms, findings, and follow-up data for each patient. At the time of patient recruitment, an independent interdisciplinary reference panel reviewed the clinical information and determined the cause of chest pain for each patient. Using multivariable regression analysis, the investigators determined clinical predictors helping to confirm or exclude CHD in women and men.
Compared with men, women were diagnosed with more psychogenic disorders (11.2% vs 7.3%; P = .02). However, men were more likely to have CHD (17.2% vs 13.0%; P = .04), trauma (5.1% vs 1.8%; P < .001), and pneumonia/pleurisy (3.0% vs 1.3%; P = .04), and chest pain was more often localized on the right side of the chest (25.0% vs 9.1%; P = .01).
Factors positively associated with CHD in both sexes were age, known clinical vascular disease, and pain worse with exercise. Pain duration of more than 1 hour was positively associated with CHD in women, whereas shorter pain durations were associated with CHD in men. There were negative associations for stinging pain in women and for pain affected by inspiration and localized muscle tension in men.
Limitations of this study include only limited clinical data available to the reference panel and possible incorporation bias regarding the final diagnoses.
"We found gender differences in regard to aetiology, selected clinical characteristics and association of symptoms and signs with CHD in patients presenting with chest pain in a primary care setting," the study authors write. "Further research is necessary to elucidate whether these differences would support recommendations for different diagnostic approaches for CHD according to a patient's gender."
One of the study authors acts as scientific advisor for MSD and ESSEX.
BMC Fam Pract. Published online December 14, 2009.
