Women and South Asian people with typical pain were more likely than those with atypical pain to receive a diagnosis of angina pectoris and to have increased mortality rates or acute coronary complications, a study by UK researchers found. Despite this, in women and South Asians, both those with typical and atypical pain had lower rates of angiography and coronary interventions compared with men and white people respectively.
In this study of 7784 South Asian and white people in the United Kingdom, it was also found that more women than men and more South Asians compared with white people reported atypical chest pain and were less likely to receive a diagnosis of angina.
"Women and South Asian people with typical chest pain were at increased risk of adverse coronary outcomes compared with those who presented with atypical pain," state Dr. Justin Zaman of University College London and UK-based colleagues.
Differences in the description of symptoms did not account for the lower rates of intervention. "Further study should examine why South Asians and white women with potentially the same adverse prognosis as men received poorer care," state the researchers.
In a related commentary, Dr. Deborah Diercks from the University of California and coauthor Dr. Chadwick Miller of Wake Forest University ask whether misdiagnoses occur because of the way patients report symptoms or clinician misinterpretation or bias. They point out that "patients with atypical chest pain are still at significant risk for cardiac disease….and patients with typical symptoms, regardless of ethnic background or sex, should receive further cardiac evaluation to minimize the impact of cardiac disease."
Contact for research: Ruth Metcalfe, Media Relations Manager, University College London, +44 (0)20 7679 9739, r.metcalfe@ucl.ac.uk , for Dr. Justin Zaman
Contact for commentary: Dr. Deborah Diercks, University of California, David Medical Centre, cell 916-838-9618, dbdiercks@ucdavis.edu or Chadwick Miller, Wake Forest University School of Medicine, cmiller@wfubmc.edu
Canadian Medical Association Journal