Do Sex Inequalities Extend to Rapid Access Chest Pain Clinics (RACPCs)?

Abstract

Background: Sex differences in rates of referral, investigation, and outcomes have been reported in relation to coronary heart disease. Few have examined this for patients referred by primary care to rapid access chest pain clinics (RACPC), the objective of the current study. Methods: Data were collected on patients referred to a RACPC at a district general hospital in the northwest of England from January 2001 to May 2003. Sex differences relating to history, investigation, and subsequent referrals were examined using logistic regression (men to women) adjusting for age quartiles. Results: Over 29 months, 2039 patients were referred to the RACPC; 48% (987 of 2039) were women and mean age was similar in women (55.8, standard deviation [SD] 11.3, range 18–88 years) and men (53.1, SD 12.09, range 18–83 years). More men (23.1%) smoked than women (17.5%) (odds ratio [OR] adjusted age 1.31, 95% confidence interval [CI] 1.05–1.64, P = 0.02). Positive exercise tolerance tests (Bruce protocol) were observed for 10.8% (107 of 987) women and 17.1% (180 of 1052) men (OR adjusted age 1.95, 95% CI 1.49–2.54, P = 0.001), of whom 143 were known to have been referred for angiography (44.8% women, 52.8% men, OR adjusted age 1.41, 95% CI 0.86–2.31, P = 0.18). Older people were less likely to have had angiography (OR adjusted sex 0.74, 95% CI 0.57–0.96, P = 0.02). Conclusions: Similar numbers of men and women were referred for rapid access chest pain assessment, but fewer women had positive tests. The higher rate of possibly unnecessary tests in women has cost implications and may increase patient anxiety. No sex differences were found for referral for angiography, but older people were less likely to receive investigation after positive exercise tests. Future analysis will consider sex and age differences for medical and surgical management and outcomes among this cohort.