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Sex Differences in Patients Presenting to ED With Syncope
Study Questions:
Are there sex-specific differences in the outcomes and management of syncope?
Methods:
Patients presenting to the emergency department (ED) in Alberta, Canada from 2007-2015 with a primary diagnosis of syncope were included. ED and inpatient hospital records were linked to determine if patients were admitted. Outcomes included all-cause mortality at 30 days and 1 year. Association between sex and outcomes was assessed using multivariable mixed-effect logistic regression.
Results:
Of 63,274 patients presenting to the ED with syncope, 33,986 (53.7%) were women and 29,288 (46.3%) were men (p < 0.01). Women were younger (51.6 ± 23.8 vs. 55.1 ± 20.9 years, p < 0.01), less likely to arrive by ambulance (48.4% vs. 51.7%, p < 0.001), and had fewer comorbidities (67.9% women vs. 61.8% men with Charlson comorbidity score = 0; p < 0.001). Fewer women were admitted (12.6% vs. 16.8%, p < 0.001). Women had lower mortality, regardless of admission/discharge status (30-day admitted: 2.9% women and 4.4% men, p < 0.001; discharged: 0.2% women and 0.4% men, p < 0.001 and 1-year admitted: 12.6% women and 16.1% men, p < 0.001; discharged: 2.4% women and 3.7% men, p < 0.001). Men had 1.4-fold higher odds of death at 1-year after adjusting for confounders.
Conclusions:
More women than men present to the ED with syncope. Women are less likely to be admitted and have lower mortality, regardless of discharge status.
Perspective:
This is a large study of administrative codes of syncope in the ED; therefore, differentiating among different types of syncope was not possible. Despite this limitation, women with syncope had fewer comorbidities, were younger, and presented less acutely (i.e., not by ambulance), and this likely explains why women were less likely to be admitted and had lower 30-day and 1-year mortality. From this, we can infer that low-risk women were appropriately discharged from the ED. No sex-specific treatment disparities or biological differences were observed in this study. This study illustrates the importance of controlling for confounding variables when analyzing sex differences.
Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Arrhythmias, Cardiac, Comorbidity, Emergency Service, Hospital, Healthcare Disparities, Hospital Records, Inpatients, Outcome Assessment, Health Care, Secondary Prevention, Syncope, Patient Discharge, Women
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