Abstract：
Discrepancies in cardiovascular care for women are well described, but few data assess the entire patient journey for chest pain care.
This study aimed to assess sex differences in epidemiology and care pathways from emergency medical services (EMS) contact through to clinical outcomes following discharge.
This is a state-wide population-based cohort study including consecutive adult patients attended by EMS for acute undifferentiated chest pain in Victoria, Australia (January 1, 2015, to June 30, 2019). EMS clinical data were individually linked to emergency and hospital administrative datasets, and mortality data and differences in care quality and outcomes were assessed using multivariable analyses.
In 256,901 EMS attendances for chest pain, 129,096 attendances (50.3%) were women, and mean age was 61.6 years. Age-standardized incidence rates were marginally higher for women compared with men (1,191 vs 1,135 per 100,000 person-years). In multivariable models, women were less likely to receive guideline-directed care across most care measures including transport to hospital, prehospital aspirin or analgesia administration, 12-lead electrocardiogram, intravenous cannula insertion, and off-load from EMS or review by emergency department clinicians within target times. Similarly, women with acute coronary syndrome were less likely to undergo angiography or be admitted to a cardiac or intensive care unit. Thirty-day and long-term mortality was higher for women diagnosed with ST-segment elevation myocardial infarction, but lower overall.
Substantial differences in care are present across the spectrum of acute chest pain management from first contact through to hospital discharge. Women have higher mortality for STEMI, but better outcomes for other etiologies of chest pain compared with men.
This study aimed to assess sex differences in epidemiology and care pathways from emergency medical services (EMS) contact through to clinical outcomes following discharge.
This is a state-wide population-based cohort study including consecutive adult patients attended by EMS for acute undifferentiated chest pain in Victoria, Australia (January 1, 2015, to June 30, 2019). EMS clinical data were individually linked to emergency and hospital administrative datasets, and mortality data and differences in care quality and outcomes were assessed using multivariable analyses.
In 256,901 EMS attendances for chest pain, 129,096 attendances (50.3%) were women, and mean age was 61.6 years. Age-standardized incidence rates were marginally higher for women compared with men (1,191 vs 1,135 per 100,000 person-years). In multivariable models, women were less likely to receive guideline-directed care across most care measures including transport to hospital, prehospital aspirin or analgesia administration, 12-lead electrocardiogram, intravenous cannula insertion, and off-load from EMS or review by emergency department clinicians within target times. Similarly, women with acute coronary syndrome were less likely to undergo angiography or be admitted to a cardiac or intensive care unit. Thirty-day and long-term mortality was higher for women diagnosed with ST-segment elevation myocardial infarction, but lower overall.
Substantial differences in care are present across the spectrum of acute chest pain management from first contact through to hospital discharge. Women have higher mortality for STEMI, but better outcomes for other etiologies of chest pain compared with men.
摘要：
背景：描述了女性心血管护理的差异，但是很少有数据评估整个患者的胸痛护理过程。
目的：本研究旨在评估从急诊医疗服务（EMS）接触到出院后临床结果的流行病学和护理途径的性别差异。
方法：这是一项基于全州人群的队列研究，包括维多利亚州因急性未分化胸痛而接受EMS治疗的连续成年患者，澳大利亚（2015年1月1日至2019年6月30日）。EMS临床数据分别与急诊和医院管理数据集相关联，使用多变量分析评估死亡率数据以及护理质量和结局的差异.
结果：在256,901例胸痛的EMS出勤率中，129,096人(50.3%)为女性,平均年龄为61.6岁。女性的年龄标准化发病率略高于男性（每100,000人年1,191对1,135）。在多变量模型中，在大多数护理措施中，女性接受指南指导的护理的可能性较小，包括送往医院，院前阿司匹林或镇痛给药，12导联心电图,静脉插管插入,并在目标时间内从EMS卸载或由急诊科临床医生审查。同样，患有急性冠脉综合征的女性接受血管造影或入院心脏或重症监护病房的可能性较小.诊断为ST段抬高型心肌梗死的女性30天和长期死亡率较高，但总体较低。
结论：从首次接触到出院的急性胸痛治疗范围内的护理存在很大差异。STEMI的女性死亡率较高，但与男性相比，其他胸痛病因的结局更好。
目的：本研究旨在评估从急诊医疗服务（EMS）接触到出院后临床结果的流行病学和护理途径的性别差异。
方法：这是一项基于全州人群的队列研究，包括维多利亚州因急性未分化胸痛而接受EMS治疗的连续成年患者，澳大利亚（2015年1月1日至2019年6月30日）。EMS临床数据分别与急诊和医院管理数据集相关联，使用多变量分析评估死亡率数据以及护理质量和结局的差异.
结果：在256,901例胸痛的EMS出勤率中，129,096人(50.3%)为女性,平均年龄为61.6岁。女性的年龄标准化发病率略高于男性（每100,000人年1,191对1,135）。在多变量模型中，在大多数护理措施中，女性接受指南指导的护理的可能性较小，包括送往医院，院前阿司匹林或镇痛给药，12导联心电图,静脉插管插入,并在目标时间内从EMS卸载或由急诊科临床医生审查。同样，患有急性冠脉综合征的女性接受血管造影或入院心脏或重症监护病房的可能性较小.诊断为ST段抬高型心肌梗死的女性30天和长期死亡率较高，但总体较低。
结论：从首次接触到出院的急性胸痛治疗范围内的护理存在很大差异。STEMI的女性死亡率较高，但与男性相比，其他胸痛病因的结局更好。
