Murga-Eizagaetxebarría Nekane, Rodríguez-Padial Luis, Muñiz Javier, Sambola Antonia, Gómez-Doblas Juan José, Pedreira Milagros, Alonso-Martín Joaquín J, Beltran Paola, Rodríguez-Roca Gustavo, Anguita Manuel, Roig Eulalia
Dirección General de Planificación, Ordenación y Evaluación Sanitaria, Departamento de Salud, Gobierno Vasco, Vitoria, Álava, Spain.
Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain.
Rev Esp Cardiol (Engl Ed). 2019 Oct;72(10):813-819. doi: 10.1016/j.rec.2018.11.021. Epub 2019 Apr 7.
To analyze differences between sexes in the clinical management of patients presenting with symptoms of chest pain and/or palpitations within a population-based study.
The OFRECE study included a random sample of 8400 individuals from the Spanish population aged 40 years and older; 1132 (13.5%) had previously consulted for chest pain and 1267 (15.1%) had consulted for palpitations and were included in the present study. We calculated both the crude and adjusted odds ratios (OR) of undergoing certain tests and the results of consultations by sex. Adjustment was performed by classic cardiovascular risk factors, a personal history of cardiovascular disease, and a diagnosis of stable angina or atrial fibrillation confirmed in the OFRECE study in each case.
No differences were observed in history of consultation for chest pain between women and men (13% vs 14.1%; P=.159) but differences were found in palpitations (19% vs 10.4%, respectively; P <.001). Women who had previously consulted for chest pain underwent fewer echocardiograms (32.5% vs 45.3%, respectively; P <.001), were less frequently referred to a cardiologist (49.1% vs 60.1%; P <.001), were less often admitted to hospital (20.1% vs 39.4%; P <.001), and less frequently received a confirmed diagnosis (60.9 vs 71, 9; P <.001). After full adjustment, all differences decreased and become nonsignificant echocardiograms: adjusted OR, 0.81; 95%CI, 0.60-1.09; referral to a cardiologist: adjusted OR, 0.86; 95%CI, 0.63-1.16; hospital admission: adjusted OR, 0.76; 95%CI, 0.54-1.09). For palpitations, crude differences were smaller and all became nonsignificant after adjustment.
This study does not confirm the existence of sex-related bias in the management of chest pain and palpitations. However, such bias cannot be completely ruled out in diagnoses confirmed within the OFRECE study, which might limit its ability to detect sex-related differences in health care.
在一项基于人群的研究中，分析胸痛和/或心悸症状患者临床管理中的性别差异。
OFRECE研究纳入了来自西班牙40岁及以上人群的8400名个体的随机样本；1132人（13.5%）曾因胸痛就诊，1267人（15.1%）曾因心悸就诊，均纳入本研究。我们计算了进行某些检查的粗比值比（OR）和调整后的比值比以及按性别划分的会诊结果。通过经典心血管危险因素、心血管疾病个人史以及在OFRECE研究中每例确诊的稳定型心绞痛或心房颤动诊断进行调整。
男女之间胸痛就诊史无差异（分别为13%和14.1%；P = 0.159），但心悸方面存在差异（分别为19%和10.4%；P < 0.001）。曾因胸痛就诊的女性接受超声心动图检查的较少（分别为32.5%和45.3%；P < 0.001），被转诊至心脏病专家处的频率较低（49.1%和60.1%；P < 0.001），住院频率较低（20.1%和�39.4%；P < 0.001），确诊频率较低（60.9%和71.9%；P < 0.001）。完全调整后，所有差异均减小且超声心动图检查变得无统计学意义：调整后的OR为0.81；95%CI为0.60 - 1.09；转诊至心脏病专家处：调整后的OR为0.86；95%CI为0.63 - 当1.16；住院：调整后的OR为0.76；95%CI为0.54 - 1.09）。对于心悸，粗差异较小，调整后均无统计学意义。
本研究未证实胸痛和心悸管理中存在性别相关偏倚。然而，在OFRECE研究确诊的病例中，这种偏倚不能完全排除，这可能限制了其检测医疗保健中性别相关差异的能力。
