Gender and stress test use in an ED chest pain unit

Background: Women with acute coronary syndrome appear to be treated less aggressively than men. However, little is known about potential sex biases in the evaluation of patients with low-risk chest pain admitted to emergency department (ED) chest pain units. Methods: This was a secondary analysis of prospectively collected data on consecutively admitted chest pain unit patients in a large-volume academic urban ED. Thrombolysis in myocardial infarction (TIMI) risk prediction and Diamond and Forrestor (D&F) scores were calculated for each patient. χ ² And t tests were used for univariate comparisons of demographics, cardiac comorbidities, risk scores, and stress testing between sexes. Multivariable logistic regression was used to estimate odds ratios (ORs) for testing based on sex, controlling for race, insurance status, and either TIMI or D&F score. Results: Eight hundred eleven patients were enrolled (48% male, 52% female) in the study. The mean age for men was 52 ± 12 and 54 ± 12 years for women (P <.01). Men had a higher mean D&F score (42.0 vs 24.4; P <.01), but TIMI risk scores did not differ between sexes. Women received testing more often than men, a difference that was not statistically significant (50% [95% confidence interval {CI}, 45%-55%] vs 43% [95% CI, 39%-48%]; probability ratio of 1.16; P =.19). Women had a higher OR for receiving stress testing (1.61, 95% CI 1.14-2.29 controlling for TIMI score; OR, 1.69, 95% CI 1.12-2.51 controlling for D&F score). Conclusions: This study demonstrates no association between physician discretionary uses of stress testing based on sex. There is a need for further research on patient- or provider-specific factors that determine stress use and on how differences may affect clinical outcomes.