Type of Document Thesis Author Decker, Kimberlee Dawne Author's Email Address email@example.com URN etd-07052007-151250 Title A Comparison Study of the Treatment of Chest Pain in Men and Women in the Emergency Department Degree Master of Science Department Nursing, School of Advisory Committee
Advisor Name Title James Whyte IV Committee Chair Dianne Speake Committee Member Laurie Grubbs Committee Member Keywords
- Cardiovascular Disease
- Gender Bias
Date of Defense 2007-06-28 Availability unrestricted AbstractABSTRACT
Cardiovascular disease is the number one killer in the United States. Decades of research have indicated that controlling risk factors can reduce the incidence of this disease in the population. And, early treatment of symptoms can greatly improve outcomes in patients who develop cardiovascular disease. However, women have not had the same improvement in either incidence of the disease or decrease in morbidity and mortality. The purpose of this study was to determine the types of treatment received by patients presenting to an emergency department with chest pain in an attempt to identify any possible causes for this discrepancy.
A sample of one hundred charts of patients receiving treatment at an emergency department was reviewed. The types of diagnostic testing conducted and treatments received by the patients were recorded from the record. In addition, time variables related to the testing and treatment were collected. Inclusion criteria was limited to those patients between the ages of 35 and 65 presenting to the emergency department with a chief complaint of chest pain. They must also have had a discharge diagnosis from the emergency department of ICD-9 410, acute myocardial infarction, ICD-9 411, acute coronary syndrome, ICD-9 412, old myocardial infarction, ICD-9 413, or ICD-9 414, coronary ischemia. The total number of records available was approximately 900.
The hypotheses were in regards to the presence of a relationship between treatment and gender. Student’s t test, t-test for Equality of the Means (with a 95% CI), and Chi-square were used to identify any possible relationship. Time variables were analyzed using an ANOVA. In the case where more than one factor was found to have an influence, a two way ANOVA was conducted. In regards to diagnostic testing and treatment, there was a significant difference in emergent coronary angiography. Women did not receive emergent coronary angiography as frequently as men (÷˛= 2.406, df=1, p= .007). Time variables were analyzed with significant differences in time to care (t= -2.963, df = 98, p= .005), time to oxygen (t = -3.228, df = 40.156, p=0.003), time to morphine (t = -4.624, df = 13.113, p<0.001), and time to Troponin (t = -2.340, df = 83.814, p=0.022). The factor age group had a significant difference in time to care and time to Troponin. Post Hoc multiple comparisons indicated that those in the group age 57 and older had a significant difference in time to care when compared to the group less than age 49 (p<.001) and the group aged 49 to 56 (p=.013). For the variable time to Troponin, there was a significant difference between the group age 57 and older and the group less than age 49 (p< .001) and the group age
49 to 56 (p=.045). A two-way ANOVA indicated that gender had an effect on both time to care and time to Troponin as women in the younger age groups waited much longer than men to be seen and to have a Troponin assay collected.
Based on the results, it is the responsibility of the advanced practice nurse to educated their patients about factors that increase the risk for developing CVD and ways to control these factors. This includes diet, exercise, and medication regimens. In addition, frequent monitoring of both risk factor reduction and medication adherence is necessary to identify and address potential problems. Any change in a client’s state of health, especially those with CVD risk factors, must be assessed appropriately and treated promptly.
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