Sex and race differences in electrocardiogram use (the national hospital ambulatory medical care survey)

In-vivo studies do not support a major functional role for the GlyArg 1-adrenoceptor polymorphism in humans, and polymorphism varies in frequency among different ethnic groups but does not alter response in vivo.

Abstract

There are sex and race differences in many aspects of health care delivery. For example, blacks and women are less likely to receive aspirin and thrombolytic drugs. 1 Barakat K Wilkinson P Suliman A Ranjadayalan K Timmis A Acute myocardial infarction in women contribution of treatment variables to adverse outcome. Am Heart J. 2000; 140: 740-746 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar , 2 Rathore S.S Berger A.K Weinfurt K.P Feinleib M Oetgen W.J Gersh B.J Schulman K.A Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly. Circulation. 2000; 102: 642-648 Crossref PubMed Scopus (156) Google Scholar , 3 Weitzman S Cooper L Chambless L Rosamond W Clegg L Marcucci G Romm F White A Gender, racial, and geographic differences in the performance of cardiac diagnostic and therapeutic procedures for hospitalized acute myocardial infarction in four states. Am J Cardiol. 2000; 79: 722-726 Abstract Full Text Full Text PDF Scopus (119) Google Scholar Blacks and women presenting with chest pain are less likely to be referred for cardiac catheterization. 4 Schulman K.A Berlin J.A Harless W Kerner J.F Sistrunk S Gersh B.J Dube B Taleghani C.K Burke J.E Williams S Eisenberg J.M Escarce J.J The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med. 2000; 340: 618-626 Crossref Scopus (1479) Google Scholar Blacks and women diagnosed with acute myocardial infarction (AMI) are also less likely to undergo cardiac catheterization. 5 Giles W.H Anda R.F Casper M.L Escobedo L.G Taylor H.A Race and sex differences in rates of invasive cardiac procedures in US hospitals. Data from the National Hospital Discharge Survey. Arch Intern Med. 2000; 155: 318-324 Crossref Scopus (180) Google Scholar The gender differences in diagnostic evaluation after AMI appear more pronounced among younger women. 6 Vaccarino V Parsons L Every N.R Barron H.V Krumholz H.M Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants. N Engl J Med. 2000; 341: 217-225 Crossref Scopus (1049) Google Scholar The American College of Cardiology and the American Heart Association joint electrocardiography guidelines state that all patients presenting to the emergency department (ED) with chest pain should undergo electrocardiography (ECG) to rule out acute ischemia or infarction, regardless of sex or age. 7 Schlant R.C Adolph R.J DiMarco J.P Dreifus L.S Dunn M.I Fisch C Garson A Haywood L.J Levine H.J Murray J.A Noble R.J Ronan J.A Guidelines for electrocardiography. J Am Coll Cardiol. 2000; 19: 473-481 Google Scholar It is possible that sex and race differences exist in the administration of this important screening tool among patients with chest pain, possibly reflecting a lower suspicion of coronary heart disease in women (especially young women) and blacks. These management differences may result in failure to diagnose coronary heart disease and may explain why these subgroups are referred less often for cardiac catheterization. Therefore, the purpose of this study was to examine whether this basic guideline is being implemented uniformly in a national sample of patients presenting to the ED with chest pain. Specifically, we hypothesized that young women and blacks presenting with chest pain would be significantly less likely to undergo ECG relative to their white male counterparts.