Women with suspected acute coronary syndrome who have low-risk History, Electrocardiogram, Age, Risk factors, and Troponin (HEART) scores have more appropriate testing and better outcomes than men, according to a study published online Dec. 23 in the Annals of Emergency Medicine.
Salena M. Preciado, from Kaiser Permanente Southern California in Pasadena, and colleagues analyzed 34,715 adult emergency department encounters evaluated for suspected acute coronary syndrome with a documented HEART score (56 percent women).
The researchers found that more women were classified as low risk (60.5 versus 52.4 percent; odds ratio [OR], 1.39; 95 percent confidence interval [CI], 1.33 to 1.45). Compared with men, women were hospitalized or received stress testing less often for low HEART scores (18.8 versus 22.8 percent; OR, 0.79; 95 percent CI, 0.73 to 0.84) and intermediate HEART scores (46.7 versus 49.7 percent; OR, 0.88; 95 percent CI, 0.83 to 0.95), but these percentages were similar for women and men with high HEART scores (74.1 versus 74.4 percent; OR, 0.99; 95 percent CI, 0.77 to 1.28). Even after adjustment for HEART score and comorbidities, women had lower odds of hospitalization or noninvasive cardiac testing (OR, 0.82; 95 percent CI, 0.78 to 0.86). For all HEART score categories, men had a higher risk for major adverse cardiac events than women, with a significantly higher risk for low-risk HEART scores (0.4 versus 0.1 percent).
“We found after implementation of the HEART score that women received more appropriate care than men with physicians less likely to recommend low-value cardiac testing for lower and intermediate risk levels, and comparable care for those at high risk,” a coauthor said in a statement.