Key result
Male sex was a significant factor favoring actual hospital admission among emergency department patients with chest pain for whom the HEART Pathway predicted admission (p=0.007).
Why the study?
Studies have reported a negative bias in identifying myocardial ischemia in females versus males, prompting this study to determine if HEART Pathway recommendations are affected by negative bias in females.
Does sex influence real-life admission decisions compared to HEART Pathway predictions in patients presenting with chest pain to the emergency department?
Cohort (n=772)
No
Does sex influence real-life admission decisions compared to HEART Pathway predictions in patients presenting with chest pain to the emergency department?
p-value: p=0.007
Real-life admission decisions for chest pain in the ED favor males compared to the HEART Pathway protocol, suggesting potential under-admission of women with serious coronary artery disease.
May indicate sex bias in HEART Pathway application; leaves open need for prospective sex-specific validation before practice change.
Objectives: The HEART Pathway is a diagnostic protocol designed to identify low-risk patients with chest pain who can be safely discharged from the emergency department (ED) without hospitalization. Studies have reported a negative bias in identifying myocardial ischemia in females versus males and a different clinical pattern of cardiac ischemia across genders. This study sought to determine if the HEART Pathway recommendations are affected by negative bias in females. Materials and Methods: A retrospective cohort study was conducted in the ED of an academic tertiary medical center. Admission/discharge decisions made by physicians in male and female patients presenting with chest pain in 4/2014–7/2019 were compared with HEART Pathway protocol predictions. Probabilities were estimated with logistic regression analysis, and odds ratios and 95% confidence intervals were calculated. Results: The cohort included 772 patients, 485 male (63%) and 287 female (37%), of median age 54 years. On the basis of their presenting symptoms, 278 patients (36%) were admitted by the ED physician and 494 (64%) were discharged. Using the HEART Pathway protocol, 227 patients (29.4%) would be expected to be admitted and 545 (70.6%) discharged. The real-life admission rate was higher than possible with the HEART Protocol ( p = 0.001). In a regression model, male sex was a significant factor favoring admission among the patients for whom the HEART Pathway predicted admission ( p = 0.007). Conclusions: As the HEART Pathway is a validated risk-stratification tool, there is a high likelihood that serious coronary artery disease may be overlooked in women, even those who seek timely medical assistance.
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Gelber et al. (2022) conducted a cohort in Chest pain (n=772). Male sex vs. Female sex was evaluated on Admission among patients for whom the HEART Pathway predicted admission (p=0.007). Male sex was a significant factor favoring actual hospital admission among emergency department patients with chest pain for whom the HEART Pathway predicted admission (p=0.007).
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