[Comparison of the management of non-ST segment elevation myocardial infarction during emergency care according to sex of the patient]. / Comparación del manejo del infarto de miocardio sin elevación del ST durante la asistencia urgente en función del sexo del paciente.

The atypical characteristics of acute coronary syndrome in women lead to differences in management and treatment. We investigated these differences in the urgent management of non-ST-segment acute myocardial infarction (NSTEMI). Data on 39 variables were collected from 539 patients with NSTEMI treated at 97 Spanish emergency departments. After adjustment for 10 baseline differences, the only significant differences were that time-to-arrival at the emergency department was longer for women (odds ratio [OR]=0.52; 95% confidence interval [CI], 0.28-0.95) and that they received more clopidogrel (OR=1.65; 95% CI, 1.06-2.56). The trend to fewer admissions to coronary or intensive care units (42.9% vs 55.6%) and fewer catheterization procedures (29.7% vs 40.7%) disappeared after adjustment. We conclude that there are virtually no differences in treatment in women with N-STEMI in prehospital and emergency care.

Sex differences in the treatment of patients with atrial fibrillation: population-based study in a local health district.

Differences in the treatment of atrial fibrillation between men and women were investigated by using patients in a local health district as a reference population. The study included 688 patients (359 female) who presented with atrial fibrillation. Women were older, more frequently had heart failure, and were more often functionally dependent than men. With regards to the management of atrial fibrillation, women were prescribed digoxin more frequently than men, but underwent electrical cardioversion less often, were less frequently seen by a cardiologist, and understood less about their treatment. After stratifying the findings by age and adjusting for heart failure and the degree of functional dependence, it was observed that women aged over 85 years were prescribed digoxin more often than men, while women aged under 65 years underwent cardioversion less often than men. In conclusion, gender differences observed in the treatment of atrial fibrillation cannot be fully explained by differences in clinical characteristics between men and women in the population.

[Influence of patient's sex in the form of presentation and the management of acute heart failure in Spanish emergency rooms]. / Influencia del sexo del paciente en la forma de presentación y en el tratamiento de la insuficiencia cardíaca aguda en los servicios de Urgencias españoles.

BACKGROUND AND OBJECTIVE: To evaluate the differences by sex in clinic presentation, diagnostic approach and initial treatment in patients with acute heart failure who are attended in emergency rooms. PATIENTS AND METHODS: Prospective, evaluated, descriptive, transverse and multicentric study, which includes all patients attended by acute heart failure in emergency rooms of 10 Spanish centers between April 15th and May 15th, 2007 (n=944). Data were recorded regarding socio-demographic, comorbidity, previous heart disease, complementary explorations, previous home treatment, and therapeutic measurements in emergency. RESULTS: Regarding men, women (n=501; 53%) were older (79+/-9 and 75+/-10, P<.001), and had more hypertension (83,4% vs 74,9%, P<.01), valvular heart disease (23,1% vs 17,8%, P<.05) and obesity (21,9% vs 15,6%, P<.05); however, they also had less prevalence of coronary heart disease (26,5% vs 43,3%, P=.001) and smoking (4,4 % vs 18,7%, P<.001). According to outpatient treatment, women were less likely to be treated with beta blockers (19,6% vs 30,2%, P<.001) and antithrombotics (34,1% vs 41,3%, P<.05). Treatment administered in the emergency was similar in both groups, yet women received more frequently digoxin (25,7% vs 17,4%, P<.01). Moreover, women were admitted to the cardiology department less often (8,0% vs 13,8%, P<.01). CONCLUSIONS: In emergency, the diagnostic and therapeutic approach is very similar in both sexes and the most cases, differences can be justified due to the different patients' profile and the ambulatory handling before their consultation to emergency.