Abstract：
BACKGROUND: Palpitations represent a common clinic complaint.
OBJECTIVE: To explore gender and age differences in the evaluation and outcomes of patients with palpitations in outpatient settings.
METHODS: This is a retrospective observational study of 58,543 patients with no known structural cardiac disease or arrythmias presenting to primary care and cardiology clinics in an integrated health system in California with palpitations between January 2017 and December 2021. The primary and secondary endpoints were hospitalization for arrhythmia and all-cause mortality at 1 year. Multivariable logistic regression models evaluated the association between gender, age, and outcomes.
RESULTS: Men and women were equally as likely to be started on beta-blockers (adjusted OR 0.96, 95% CI 0.90-1.02) and evaluated with electrocardiograms (adjusted OR 0.95, 95% CI 0.90-1.01) and cardiac monitors (adjusted OR 1.04, 95% CI 0.99-1.08). Patients who completed Holter or event monitors had a lower rate of hospitalization for cardiovascular disease at 1 year than those without (2.3% vs. 2.7%, p = 0.001). At 1 year, women had a lower risk of all-cause mortality (adjusted OR 0.47, 95% CI 0.35-0.64) and hospitalization for atrial fibrillation (adjusted OR 0.47, 95% CI 0.30-0.72) and arrhythmias (adjusted OR 0.73, 95% CI 0.58-0.91) compared to men. Among older women and men (≥ 80 years), there was no significant difference in 1-year all-cause mortality (adjusted OR 0.57, 95% CI 0.29-1.12), hospitalization for atrial fibrillation (adjusted OR 0.58, 95% CI 0.17-1.97), or arrhythmias (adjusted OR 1.15, 95% CI 0.12-11.07).
CONCLUSIONS: There were no gender differences in referrals for cardiac monitoring or prescriptions for beta-blockers. Women had a better prognosis with a lower risk of hospitalization for arrhythmias and death at 1 year compared to men. However, 1-year risks for mortality and hospitalization for arrythmias among older women were comparable to those of older men, underscoring the importance of considering age and gender in managing patients with palpitations.
OBJECTIVE: To explore gender and age differences in the evaluation and outcomes of patients with palpitations in outpatient settings.
METHODS: This is a retrospective observational study of 58,543 patients with no known structural cardiac disease or arrythmias presenting to primary care and cardiology clinics in an integrated health system in California with palpitations between January 2017 and December 2021. The primary and secondary endpoints were hospitalization for arrhythmia and all-cause mortality at 1 year. Multivariable logistic regression models evaluated the association between gender, age, and outcomes.
RESULTS: Men and women were equally as likely to be started on beta-blockers (adjusted OR 0.96, 95% CI 0.90-1.02) and evaluated with electrocardiograms (adjusted OR 0.95, 95% CI 0.90-1.01) and cardiac monitors (adjusted OR 1.04, 95% CI 0.99-1.08). Patients who completed Holter or event monitors had a lower rate of hospitalization for cardiovascular disease at 1 year than those without (2.3% vs. 2.7%, p = 0.001). At 1 year, women had a lower risk of all-cause mortality (adjusted OR 0.47, 95% CI 0.35-0.64) and hospitalization for atrial fibrillation (adjusted OR 0.47, 95% CI 0.30-0.72) and arrhythmias (adjusted OR 0.73, 95% CI 0.58-0.91) compared to men. Among older women and men (≥ 80 years), there was no significant difference in 1-year all-cause mortality (adjusted OR 0.57, 95% CI 0.29-1.12), hospitalization for atrial fibrillation (adjusted OR 0.58, 95% CI 0.17-1.97), or arrhythmias (adjusted OR 1.15, 95% CI 0.12-11.07).
CONCLUSIONS: There were no gender differences in referrals for cardiac monitoring or prescriptions for beta-blockers. Women had a better prognosis with a lower risk of hospitalization for arrhythmias and death at 1 year compared to men. However, 1-year risks for mortality and hospitalization for arrythmias among older women were comparable to those of older men, underscoring the importance of considering age and gender in managing patients with palpitations.
摘要：
背景：心悸是一种常见的临床主诉。
目的：探讨门诊设置的心悸患者评估和结局的性别和年龄差异。
方法：这是一项回顾性观察性研究，纳入了58,543例无已知结构性心脏病或心律失常的患者，这些患者在2017年1月至2021年12月期间就诊于加利福尼亚州的综合卫生系统的初级保健和心脏病学诊所，出现心悸。主要和次要终点是因心律失常住院和1年全因死亡率。多变量逻辑回归模型评估了性别，年龄,和结果。
结果：男性和女性同样可能开始使用β受体阻滞剂（校正OR0.96，95％CI0.90-1.02），并使用心电图（校正OR0.95，95％CI0.90-1.01）和心脏监测仪（校正OR1.04，95％CI0.99-1.08）进行评估。完成动态心电图或事件监测仪的患者在1年内因心血管疾病住院率低于未完成的患者（2.3％vs.2.7%,p=0.001)。在1年,与男性相比,女性患者的全因死亡率(校正OR0.47,95%CI0.35~0.64)和房颤住院(校正OR0.47,95%CI0.30~0.72)及心律失常(校正OR0.73,95%CI0.58~0.91)风险较低.在老年女性和男性（≥80岁）中，1年全因死亡率无显著差异(校正OR0.57,95%CI0.29-1.12),房颤住院（校正OR0.58，95%CI0.17-1.97），或心律失常（校正OR1.15，95%CI0.12-11.07）。
结论：心脏监护转诊或β受体阻滞剂处方没有性别差异。与男性相比，女性预后更好，1年时因心律失常住院和死亡的风险较低。然而,老年女性的一年死亡率和住院风险与老年男性相当，强调在治疗心悸患者时考虑年龄和性别的重要性。
目的：探讨门诊设置的心悸患者评估和结局的性别和年龄差异。
方法：这是一项回顾性观察性研究，纳入了58,543例无已知结构性心脏病或心律失常的患者，这些患者在2017年1月至2021年12月期间就诊于加利福尼亚州的综合卫生系统的初级保健和心脏病学诊所，出现心悸。主要和次要终点是因心律失常住院和1年全因死亡率。多变量逻辑回归模型评估了性别，年龄,和结果。
结果：男性和女性同样可能开始使用β受体阻滞剂（校正OR0.96，95％CI0.90-1.02），并使用心电图（校正OR0.95，95％CI0.90-1.01）和心脏监测仪（校正OR1.04，95％CI0.99-1.08）进行评估。完成动态心电图或事件监测仪的患者在1年内因心血管疾病住院率低于未完成的患者（2.3％vs.2.7%,p=0.001)。在1年,与男性相比,女性患者的全因死亡率(校正OR0.47,95%CI0.35~0.64)和房颤住院(校正OR0.47,95%CI0.30~0.72)及心律失常(校正OR0.73,95%CI0.58~0.91)风险较低.在老年女性和男性（≥80岁）中，1年全因死亡率无显著差异(校正OR0.57,95%CI0.29-1.12),房颤住院（校正OR0.58，95%CI0.17-1.97），或心律失常（校正OR1.15，95%CI0.12-11.07）。
结论：心脏监护转诊或β受体阻滞剂处方没有性别差异。与男性相比，女性预后更好，1年时因心律失常住院和死亡的风险较低。然而,老年女性的一年死亡率和住院风险与老年男性相当，强调在治疗心悸患者时考虑年龄和性别的重要性。
