Bernier Rochelle, Tran Dat T, Sheldon Robert S, Kaul Padma, Sandhu Roopinder K
University of Alberta, Edmonton, Alberta, Canada.
Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, Edmonton, Alberta, Canada.
JACC Clin Electrophysiol. 2020 Mar;6(3):341-347. doi: 10.1016/j.jacep.2019.11.002. Epub 2020 Jan 29.
This study sought to determine whether sex-specific differences in management and outcomes of syncope patients exist.
Syncope is a common presentation to the emergency department (ED) and reason for hospital admission.
Patients ≥18 years of age, presenting to the ED with a primary diagnosis of syncope in Alberta, Canada, from January 1, 2007 to December 12, 2015 were included. ED records were linked to hospital records to identify patients admitted versus discharged from the ED. Outcomes included 30-day and 1-year all-cause mortality. Multivariable mixed-effect logistic regression assessed the association between sex and outcomes.
Of the 63,274 ED syncope patients, 33,986 (53.7%) were women and 29,288 (46.3%) were men (p < 0.01). Compared with men, women were younger (51.6 ± 23.8 years for women vs. 55.1 ± 20.9 years for men; p < 0.001), less likely to arrive by ambulance (48.4% women vs. 51.7% men; p < 0.001), and had fewer comorbidities (67.9% women vs. 61.8% men with Charlson comorbidity score = 0; p < 0.001). Overall, 12.6% women and 16.8% men were admitted to hospital (p < 0.001). Regardless of discharge status, women had lower mortality rates (30-day admitted: 2.9% women and 4.4% men; p < 0.001; discharged: 0.2% women and 0.4% men; p < 0.001; and 1-year admitted: 12.6% women and 16.1% men; p < 0.001; discharged: 2.4% women and 3.7% men; p < 0.001). After adjusting for confounders, men were associated with 1.4-fold higher odds of death at 1 year. This was unchanged regardless of discharge status.
Although women are more likely than men to present to the ED with syncope, they are less likely to be admitted to hospital. Mortality rates are lower for women, regardless of discharge status.
本研究旨在确定晕厥患者在管理和预后方面是否存在性别差异。
晕厥是急诊科常见的就诊原因及住院理由。
纳入2007年1月1日至2015年12月12日期间在加拿大艾伯塔省急诊科以晕厥为主要诊断就诊的18岁及以上患者。将急诊科记录与医院记录相链接，以确定患者是从急诊科入院还是出院。结局包括30天和1年的全因死亡率。多变量混合效应逻辑回归评估性别与结局之间的关联。
在63274例急诊科晕厥患者中，33986例（53.7%）为女性，29288例（46.3%）为男性（p<0.01）。与男性相比，女性更年轻（女性为51.6±23.8岁，男性为55.1±20.9岁；p<0.001），乘坐救护车就诊的可能性更低（女性为48.4%，男性为51.7%；p<0.001），合并症更少（Charlson合并症评分为0的女性为67.9%，男性为61.8%；p<0.001）。总体而言，12.6%的女性和16.8%的男性被收治入院（p<0.001）。无论出院状态如何，女性的死亡率均较低（30天入院：女性为2.9%，男性为4.4%；p<0.001；出院：女性为0.2%，男性为0.4%；p<0.001；1年入院：女性为12.6%，男性为16.1%；p<0.001；出院：女性为2.4%，男性为3.7%；p<0.
