Sex differences in chest pain presentation, triage assessment, and outcomes in urgent primary care: findings from the TRACE cohort study

Aim: To evaluate sex differences in the triage and assessment of chest pain in Dutch out-of-hours primary care (OOH-PC). Background: Prior research illustrated differences between women and men with confirmed cardiac ischemia. However, information on sex differences among patients with undifferentiated chest pain is limited and current protocols used to assess chest pain in urgent primary care in the Netherlands do not account for potential sex differences. Methods: A retrospective cohort study of consecutive patients who contacted a large OOH-PC facility in the Netherlands in 2017 regarding chest pain. We performed descriptive analyses on sex differences in patient and symptom characteristics, triage assessment, and subsequent clinical outcomes, including acute coronary syndrome (ACS). Findings: A total of 1,802 patients were included, the median age was 54 years, and 57.6% were female. Compared to men, women less often had a history of cardiovascular disease (CVD) (16.0% vs 25.8%, p < 0.001) or cardiovascular risk factors (49.3% vs 56.0%, p = 0.005). Symptom characteristics were comparable between sexes. While triage urgencies were more frequently altered in women, the resulting triage urgencies were comparable, including ambulance activation rates (31.1% and 33.5%, respectively, p = 0.33). Musculoskeletal causes were the most common in both sexes; but women were less likely to have an underlying cardiovascular condition (21.1% vs 29.6%, p < 0.001), including ACS (5.4% vs 8.5%, p = 0.019). Conclusion: Women more frequently sought urgent primary care for chest pain than men. Despite a lower overall risk for cardiovascular events in women, triage assessment and ambulance activation rates were similar to those in men, indicating a potentially less efficient and overly conservative triage approach for women.