Sex Differences in Symptom Phenotypes Among Older Patients with Acute Myocardial Infarction - 03/03/22
, Alexandra M. Hajduk, PhD, MPH b, Erich J. Greene, PhD c, Rachel P. Dreyer, PhD d, e, Harlan M. Krumholz, MD, SM c, d, e, Sarwat I. Chaudhry, MD fAbstract |
Background |
Clinicians make a medical diagnosis by recognizing diagnostic possibilities, often using memories of prior examples. These memories, called “exemplars,” reflect specific symptom combinations in individual patients, yet most clinical studies report how symptoms aggregate in populations. We studied how symptoms of acute myocardial infarction combine in individuals as symptom phenotypes and how symptom phenotypes are distributed in women and men.
Methods |
In this analysis of the SILVER-AMI Study, we studied 3041 patients (1346 women and 1645 men) 75 years of age or older with acute myocardial infarction. Each patient had a standardized in-person interview during the acute myocardial infarction admission to document the presenting symptoms, which enabled a thorough examination of symptom combinations in individuals. Specific symptom combinations defined symptom phenotypes and distributions of symptom phenotypes were compared in women and men using Monte Carlo permutation testing and repeated subsampling.
Results |
There were 1469 unique symptom phenotypes in the entire SILVER-AMI cohort of patients with acute myocardial infarction. There were 831 unique symptom phenotypes in women, as compared with 819 in men, which was highly significant, given the larger number of men than women in the study (P < .0001). Women had significantly more symptom phenotypes than men in almost all acute myocardial infarction subgroups.
Conclusions |
Older patients with acute myocardial infarction have enormous variation in symptom phenotypes. Women reported more symptoms and had significantly more symptom phenotypes than men. Appreciation of the diversity of symptom phenotypes may help clinicians recognize the less common phenotypes that occur more often in women.
Le texte complet de cet article est disponible en PDF.Keywords : Acute myocardial infarction, Diagnostic reasoning, Gender disparities
Plan
| Funding: This research was supported by grant R01 HL115295 from the National Heart, Lung, and Blood Institute. This SILVER-AMI study was conducted at the Yale Claude D. Pepper Older Americans Independence Center (grant P30 AG021342). |
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| Conflicts of Interest: AMH, EJG, RPD report none. JEBJ receives royalties from Dementi Milestone Publishing for the book The Science of the Art of Medicine: A Guide to Medical Reasoning. HMK reports expenses and/or personal fees from UnitedHealth, IBM Watson Health, Element Science, Aetna, Facebook, the Siegfried and Jensen Law Firm, Arnold and Porter Law Firm, Martin/Baughman Law Firm, F-Prime, and the National Center for Cardiovascular Diseases in Beijing; being a cofounder of Refactor Health and HugoHealth; and grants and/or contracts from the Centers for Medicare & Medicaid Services, Medtronic, US Food and Drug Administration, Johnson & Johnson, Foundation for a Smoke-Free World, State of Connecticut Department of Public Health, and the Shenzhen Center for Health Information. SIC reports serving as a reviewer for the CVS Caremark State of Connecticut Clinical Program. The other authors report no disclosures. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
Vol 135 - N° 3
P. 342-349 - mars 2022 Retour au numéro
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