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Coronary artery disease
Original article
Sex differences in prodromal symptoms in acute coronary syndrome in patients aged 55 years or younger
  1. Nadia A Khan1,
  2. Stella S Daskalopoulou2,3,
  3. Igor Karp4,
  4. Mark J Eisenberg5,
  5. Roxanne Pelletier2,6,
  6. Meytal Avgil Tsadok2,6,
  7. Kaberi Dasgupta2,3,6,
  8. Colleen M Norris7,
  9. Louise Pilote2,3,6
  10. for the GENESIS PRAXY Team
    1. 1Department of Medicine, Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, British Columbia, Canada
    2. 2Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
    3. 3Division of General Internal Medicine, McGill University Health Center, Montréal, Québec, Canada
    4. 4Department of Social and Preventive Medicine, University of Montréal Hospital Research Center (CRCHUM), University of Montréal, Montréal, Québec, Canada
    5. 5Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
    6. 6Division of Clinical Epidemiology, McGill University Health Center, Montréal, Québec, Canada
    7. 7Faculties of Nursing, Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
    1. Correspondence to Dr Nadia Khan, Internal Medicine, University of British Columbia Faculty of Medicine, 540.7, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6; nakhanubc{at}gmail.com

    Abstract

    Background Studies suggest that young women are at highest risk for failing to recognise early symptoms of acute coronary syndrome (ACS).

    Objectives To examine sex differences in prodromal symptoms occurring days and weeks prior to the acute presentation of ACS. We also examined health-seeking behaviours and prehospital management in young patients.

    Methods Prospective cross-sectional analysis of 1145 patients (368 women) hospitalised for ACS, aged ≤55 years, from the GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary SYndrome cohort study (January 2009–April 2013). Prodromal symptoms were determined using the McSweeney Acute and Prodromal Myocardial Infarction Symptom questionnaire. Health-seeking behaviour and prehospital care were determined by questionnaires.

    Results The median age was 49 years. The prevalence of prodromal symptoms was high and more women reported symptoms than men (85% vs 72%, p<0.0001). Symptoms were similar between sexes and included unusual fatigue, sleep disturbances, anxiety and arm weakness/discomfort. Chest pain was less common in both sexes (24%). Women were more likely to seek care (49% vs 42%, p=0.04). Among those who sought care, women were more likely to use an ambulance for their ACS compared with men (52% vs 39%). Cardiovascular risk-reduction therapy use was low (≤40%) in all patients and less than half perceived their care provider suspected a cardiac source.

    Conclusions Prior to ACS, women were more likely to experience prodromal symptoms and seek medical attention than men. Prehospital care was generally similar between sexes but demonstrated underutilisation of risk-reduction therapies in at-risk young adults.

    https://doi.org/10.1136/heartjnl-2016-309945

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      Footnotes

      • Collaborators The GENESIS PRAXY Team: Louise Pilote, MD, MPH, PhD, Divisions of General Internal Medicine and Clinical Epidemiology, McGill University Health Center, Montréal, QC, Canada; Igor Karp, MD, MPH, PhD, University of Montréal Hospital Research Centre, CRCHUM and Department of Social and Preventive Medicine, University of Montréal, Montréal, QC, Canada; Simon Bacon, PhD, Concordia University and Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada; Jafna L Cox, BA, MD, FRCPC, FACC, Department of Medicine and of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada; Kaberi Dasgupta, MD, MSc, FRCPC, Research Institute of the McGill University Health Center, Montréal, QC, Canada; Stella S Daskalopoulou, MD, MSc, PhD, Research Institute of the McGill University Health Center, Montréal, QC, Canada; Mark J. Eisenberg, MD, MPH Jewish General Hospital, McGill University, Montréal, QC, Canada; James Engert, PhD, Research Institute of the McGill University Health Center, Montréal, QC, Canada; William Ghali, MD, MPH, FRCPC, University of Calgary, Calgary, AB, Canada; Karin Humphries, MBA DSc, University of British Columbia, Vancouver, BC, Canada; Nadia Khan, MD, MSc, University of British Columbia, Vancouver, BC, Canada; Kim Lavoie, PhD, University of Quebec at Montréal, UQAM and Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada; Colleen Norris, RN, PhD, University of Alberta, Edmonton, AB, Canada; Doreen Rabi, MD, FRCPC, MS, University of Calgary, Calgary, AB, Canada; Derek So, MD, FRCPC, FACC, University of Ottawa Heart Institute, Ottawa, ON, Canada; Ken D Stark, PhD, Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada; Vicky Tagalakis, MD, FRCPC, MSc, McGill University, Divisions of Internal Medicine and Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC, Canada; Meytal Avgil TSADOK, PhD, Research Institute of the McGill University Health Center, Montréal, QC, Canada; Roxanne Pelletier, PhD, Research Institute of the McGill University Health Center, Montréal, QC, Canada; George Thanassoulis, MD, FRCPC, Research Institute of the McGill University Health Center, Montréal, QC, Canada; Avi Shimony, MD, Jewish General Hospital, McGill University, Montréal, QC, Canada; Dr Krishan Ramanthan, St Paul's Hospital, Vancouver, British Columbia, Canada; Dr Jan Kornder, Surrey Memorial Hospital, Surrey, British Columbia, Canada; Drs Doreen Rabi and Todd Anderson, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Drs. Colleen Norris and Michelle Graham, University of Alberta and the Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Dr Derek So, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Dr Madhu Natarajan, McMaster University/Hamilton Health Sciences (General Site), Hamilton, Ontario, Canada; Dr Mike Rokoss, McMaster University/Hamilton Health Sciences (Juravinski Site); Hamilton, Ontario, Canada; Dr Michele Turek, Ottawa Hospital, Ottawa, Ontario, Canada; Dr Asim Cheema, St Michael's Hospital, Toronto, Ontario, Canada; Dr Shahar Lavi, London Health Sciences Centre, London, Ontario, Canada; Dr Sherryn Roth, The Scarborough Hospital, General Division, Scarborough, Ontario, Canada; Dr Thao Huynh, Hôpital Général de Montréal, Montréal, Québec, Canada; Dr Viviane Nguyen, Hôpital Royal Victoria, Montréal, Québec, Canada; Dr Mark Eisenberg, Hôpital Général Juif-Sir Mortimer B Davis, Montréal, Québec, Canada; Dr Julie Méthot, Institut universitaire de cardiologie et de pneumologie de Québec (Hôpital Laval), Québec, Québec, Canada; Dr Michel Doucet, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Dr Martine Montigny, Cité de la Santé de Laval, Laval, Québec, Canada; Dr Samer Mansour, Hôtel Dieu du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Dr Claude Lauzon, Centre de santé et de services sociaux de la région de Thetford, Thetford Mines, Québec, Canada; Dr Tomas Cieza, CSSS Chicoutimi, Chicoutimi, Québec, Canada; Dr Michel Nguyen, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada; Dr François Grondin, CSSS Alphonse Desjardins (CHAU—Hôtel-Dieu de Lévis), Lévis, Québec, Canada; Dr Jafna Cox, Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada; Dr Peter Fong, The New Brunswick Heart Centre Research Initiative and The New Brunswick Heart Centre, New Brunswick, Canada; Dr Dhananjai Menzies, Basset Healthcare, Cooperstown, New York, USA; Dr Nicolas Rodondi, Inselspital, University of Bern, Switzerland and Lausanne University Hospital, Lausanne, Switzerland.

      • Contributors NAK, LP, IK, SSD, MJE, CMN contributed to the design of the study. LP and MAT contributed to data collection and NAK, LP, RP, MAT contributed towards analysis. All authors contributed to interpretation of the results, and meaningful contribution to writing and accepting the final manuscript. NAK and LP had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

      • Funding This study was funded by the Canadian Institutes of Health Research (CIHR) and the Heart and Stroke Foundations of Quebec, Nova Scotia, Alberta, Ontario and Yukon and British Columbia, Canada. NAK is funded by a Michael Smith Foundation for Health Research Career Scientist award. LP, KD and SSD are supported by the Fonds de recherche du Québec (FRQS) award. SSD is supported through FRQS—Sociétéquébécoised'hypertensionarterielle—Jacques de Champlain Clinician Scientist Career Award. IK is a CIHR New Investigator and an FRSQ Junior 1 Scholar. LP holds a James McGill Chair in medicine.

      • Competing interests None declared.

      • Ethics approval McGill Ethics Board and at all local IRBs.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data sharing statement Investigators interested in working with these data should please contact Jasmine Poole, study coordinator: jpoole@epimgh.mcgill.ca or Dr Louise Pilote, Principal Investigator: louise.pilote@mcgill.ca.