Abstract
Background: Palpitations represent a common complaint in primary care clinics. Although usually benign, palpitations are occasionally a manifestation of cardiac arrhythmias. Aims: This study aimed to investigate whether there are gender differences in the cardiac testing pattern and clinical outcomes of patients evaluated in outpatient clinics for palpitations. Methods: This is a retrospective observational study that included adult men and women who presented to an outpatient primary care or cardiology office in an integrated health system in California with a chief complaint of palpitations. Cardiac testing pattern was captured using electronic health records. The primary endpoint was hospitalization for arrhythmia at one year. The secondary endpoint was all-cause mortality at one year. Logistic regression models were constructed to evaluate the association between female gender and the outcomes. Results: Between 2017 and 2021, 89,680 patients were evaluated for palpitations, among whom 61,064 (68.1%) were women. A high proportion of women were Hispanic. Women were more likely to be obese and less likely to have hypertension, diabetes, atrial fibrillation, heart failure, or a history of myocardial infarction. A slightly higher proportion of women were started on beta-blockers (12.8% women vs. 12.2% men, p=0.004). Women were more likely to be referred for cardiac rhythm monitoring (19.8% women vs. 18.8% men, p <0.001). At one year, women had a lower rate of hospitalization for arrhythmias (0.5% in men versus 0.3% in women, adjusted OR 0.73, 95% CI 0.58-0.91). All-cause mortality was also lower for women at one year (adjusted OR 0.55, 95% CI 0.48-0.62). Conclusion: Among patients with palpitations, women were more likely than men to be treated with beta-blockers and referred for cardiac rhythm monitoring. Women had a better clinical prognosis, with a lower risk of hospitalization for arrhythmias and death at one year.
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