Résumé
Abstract
Objectives: Cardiovascular diseases (CVD) are the main cause of death worldwide and despite a higher prevalence in
men, mortality from CVD is higher among women. Few studies have assessed sex differences in chest pain management
in ambulatory care. The objective of this post hoc analysis of data from a prospective cohort study was to assess sex
differences in the management of chest pain in ambulatory care.
Setting: We used data from the Thoracic Pain in Community cohort study that was realized in 58 primary care
practices and one university ambulatory clinic in Switzerland.
Participants: In total, 672 consecutive patients aged over 16 years attending a primary care practice or ambulatory care
clinic with a complaint of chest pain were included between February and June 2001. Their mean age was 55.2 years and
52.5% were women.
Main outcome measures: The main outcome was the proportion of patients referred to a cardiologist at 12 months
follow-up. A panel of primary care physicians assessed the final diagnosis retained for chest pain at 12 months.
Results: The prevalence of chest pain of cardiovascular origin (n = 108, 16.1%) was similar for men and women (17.5% vs
14.8%, respectively, p = 0.4). Men with chest pain were 2.5 times more likely to be referred to a cardiologist than women
(16.6% vs 7.4%, odds ratio: 2.49, 95% confidence interval: 1.52–4.09). After adjustment for the patients’ age and cardiovascular
disease risk factors, the estimates did not significantly change (odds ratio: 2.30, 95% confidence interval: 1.30–3.78).
Conclusion: Although the same proportion of women and men present with a chest pain of cardiovascular origin in
ambulatory care, there is a strong sex bias in their management. These data suggest that effort must be made to assure
equity between men and women in medical care.