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Age and sex differences in presentation of symptoms among patients with acute coronary disease: the REACT trial

Goldberg, Robert J. a; Goff, David b; Cooper, Lawton c; Luepker, Russell d; Zapka, Jane a; Bittner, Vera e; Osganian, Stavroula a; Lessard, Darleen a; Cornell, Carol e; Meshack, Angela f; Mann, Clay g; Gilliland, Janice e; Feldman, Henry h

Pathophysiology and Natural History

Background There are few data on possible age and sex differences in presentation of symptoms for patients with acute coronary disease.

Objective To investigate demographic differences in presentation of symptoms at the time of hospital presentation for acute myocardial infarction (AMI) and unstable angina.

Methods The medical records of patients who presented with chest pain and who also had diagnoses of AMI (n  = 889) or unstable angina (n  = 893) on discharge from 43 hospitals were reviewed as part of data collection activities of the Rapid Early Action for Coronary Treatment trial based in 10 pair-matched communities throughout the USA.

Results Dyspnea (49%), arm pain (46%), sweating (35%), and nausea (33%) were commonly reported by men and women of all ages in addition to the presenting complaint of chest pain. After we had controlled for various characteristics through regression modeling, older persons with AMI were significantly less likely than were younger persons to complain of arm pain and sweating, and men were significantly less likely to report vomiting than were women. Among persons with unstable angina, arm pain and sweating were reported significantly less often by elderly patients. Nausea and back, neck, and jaw pain were more common complaints of women.

Conclusions Results of this study suggest that there are differences between symptoms at presentation of men and women, and those in various age groups, hospitalized with acute coronary disease. Clinicians should be aware of these differences when diagnosing and managing patients suspected to have coronary heart disease.

aUniversity of Massachusetts Medical School, Worcester, Massachusetts, USA bBowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA cUniversity of Minnesota School of Public Health, Minneapolis, Minnesota, USA dNational Heart, Lung, and Blood Institute, Division of Epidemiology and Clinical Applications, II Rockledge Center, Bethesda, Maryland, USA eUniversity of Alabama School of Medicine at Birmingham, Birmingham, Alabama, USA fUniversity of Texas School of Public Health, Houston, Texas, USA gOregon Health Sciences University, Portland, Oregon, USA hNew England Research Institutes, Inc., Watertown, Massachusetts, USA

Correspondence and requests for reprints to Robert J. Goldberg, PhD, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA

Received 17 September 1999

Revised 18 November 1999

Accepted 24 November 1999

© 2000 Lippincott Williams & Wilkins, Inc.