Chest pain accounts for approximately 6.5 million visits to emergency departments (ED) and 4 million outpatient visits each year in the US. Overall, the rate of acute myocardial infarctions (AMI) are declining, however, are becoming more commonplace among young adults in the US. It has also been shown that women 55 years and younger who present with AMI have more comorbidity and have higher rates of in‐hospital death compared with young men. 

Researchers at the Grossman School of Medicine used data from the National Hospital Ambulatory Medical Care Survey to learn more about the initial evaluation in the ED of younger people with chest pain. They analyzed a nationally representative sample of more than 4,000 patient records, representing more than 29 million ER visits among adults aged 18-55 years old seen in an ED for chest pain between 2014 and 2018.

“Chest pain is the most common symptom of heart attack in adults of all ages. Despite a decline in the number of overall heart attacks, this number is rising among young adults. Young women and young Black adults have poorer outcomes after a heart attack compared to men and white adults” said Darcy Banco, M.D., M.P.H., lead author of the study and chief resident for safety and quality in the department of medicine at the NYU Grossman School of Medicine in New York City.

The data showed that:

• Women waited almost 11 minutes longer to be seen by a health care professional compared to men (48 minutes vs. 37 minutes, respectively)
• Women were less likely to have an electrocardiogram than men (74.2% vs. 78.8%, respectively).
• Women were less likely to be admitted to the hospital or an observation unit than men (12.4% vs. 17.9%, respectively).
• Compared with white women, women of any other race or ethnicity waited 15 minutes longer for their initial evaluation (58 minutes vs. 43 minutes, respectively), while men of any other race or ethnicity waited 10 minutes longer than white men (44 minutes vs. 34 minutes, respectively).
• After adjusting for age and other factors, researchers noted women and people of color waited longer for initial evaluation, but there were no significant sex or racial differences in the odds of receiving an electrocardiogram or cardiac enzyme testing.

“The findings raise many questions for future research. Do differences in wait time vary with location? Are the differences related to variation in hospital care quality, or are these differences applicable to all ERs? Lastly, do differences in wait time translate to differences in outcomes,” Banco said.

The complete study may be read here.