‘Major’ sex differences in CVD presentation, hospitalization rates in ED
Data from a nationally representative sample of ED visits in the United States show persistent sex differences in the distribution of CVD presentations, hospitalization rates and death patterns, researchers reported.
In an analysis of more than 20 million primary CV encounters from 2016 to 2018, researchers also found that women were more likely than men to present with essential hypertension, hypertensive crises, ischemic stroke, atrial fibrillation or flutter, supraventricular tachycardia or pulmonary embolism. Men were more likely than women to present with acute MI or cardiac arrest.
“Our study reports major sex differences in the distribution of CVD presentations, hospitalization rates and risk for death. Previous work has focused on sex disparities in causes of admission and outcomes in patients with acute CV diseases, but have been limited to patients admitted to hospital,” Mamas A. Mamas, DPhil, MRCP, professor of cardiology in the Keele Cardiovascular Research Group at Keele University in Staffordshire, U.K., told Healio. “What these studies do not consider is that for many acute CV diseases, patients may not survive to admission or the propensity for admission may be different between men and women. Studies that only focus on in-hospital admissions do not provide a true picture of the CV burden on our health systems and among men and women and whether there are differences in outcomes/process of pre-hospital admission in the ED.”
Mamas and colleagues analyzed data from primary CV encounters from the Nationwide Emergency Department Sample from 2016 to 2018, grouping CV diagnoses into 15 disease categories. The sample included 48.7% women, and median age of patients was 67 years. Men had greater overall baseline comorbidity burden; however, women had higher rates of obesity, hypertension and cerebrovascular disease.
For women, the most common ED encounters were essential hypertension (16%), hypertensive heart or kidney disease (14.1%) and AF/flutter (10.2%). For men, the most common encounters were hypertensive heart or kidney disease (14.7%), essential hypertension (10.8%) and acute MI (10.7%).
Women were more likely to present with essential hypertension, hypertensive crisis, AF/flutter, supraventricular tachycardia, PE or ischemic stroke, whereas men were more likely to present with acute MI or cardiac arrest (P < .001 for all).
In adjusted logistic regression models, researchers found that women with intracranial hemorrhage had higher risk for hospitalization and death vs. men, whereas women presenting with PE or deep vein thrombosis were less likely to be hospitalized than men. Women with aortic aneurysm/dissection had higher odds for hospitalization and death. Men were more likely to die after presentations with hypertensive heart or kidney disease, AF/flutter, acute MI or cardiac arrest, according to the researchers.
“Our study provides a more representative analysis of differences in acute CV presentations in men and women than prior work, as we have studied them in the emergency department,” Mamas told Healio. “By doing so, we are able to get a bigger picture of the health care needs of men and women, which may be used to better inform service planning and provision.”
Mamas noted that a limitation of the study is researchers were not able to capture the severity of disease presentation from the registry.
“Therefore, further work should focus around whether the differences we observe are related to differences in the quality or provision of care provided in the emergency department between men and women, or merely relates to differences in the severity of presentation,” Mamas said. “I suspect that it may be a mixture of both.”
For more information:
Mamas A. Mamas, DPhil, MRCP, can be reached at mamasmamas1@yahoo.co.uk; Twitter: @mmamas1973.
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