Sex Differences in Clinical Outcomes and Resource Utilization Among Emergency Department Patients With Unexplained Syncope or Presyncope: A Prospective, Observational, Cohort Study.

Abstract

Clinical management of emergency department (ED) patients with syncope may differ between women and men. We investigated differences by patient sex in baseline characteristics, physician risk estimation, admission rates, and clinical outcomes in patients with syncope or presyncope. Patients 40 years or older with syncope or presyncope were enrolled in a prospective, observational study across 6 EDs in the United States. Clinical, demographic, and 30-day outcomes were collected. Treating physicians provided an estimate of 30-day risk of a serious adverse event. We used risk differences and multivariable logistic regression to examine the relationship between sex and outcomes. Of 1,263 patients analyzed, 676 (53.5%) were woman. Men were more likely to have baseline cardiac disease, such as coronary artery disease (27.8% vs 11.8%; risk difference [RD]: 16%; 95% CI 11 to 20) or heart failure (15.3% vs 8.0%; RD: 7.0%; 95% CI 4 to 11). Mean physician estimate of the 30-day serious adverse event risk was 7.2% in men and 6.1% in women (RD: 1.2%; 95% CI -0.26 to 2.6). Men were more often admitted (50.4% vs 39.6%; RD: 11%; 95% CI 5 to 16). The rate of 30-day serious adverse events was higher in men (7.3% vs 4.6%; RD: 2.7%; 95% CI 0.14 to 5.5). After adjustment for baseline clinical variables, no differences in admission rates or clinical outcomes remained. There were significant baseline clinical differences between men and women with syncope or presyncope. We explained the higher admission rates and 30-day serious adverse events among men vs women by differences in baseline clinical factors.