Meta-analytic evaluation of gender differences and symptom measurement strategies in acute coronary syndromes

Objective

The objectives of this meta-analytic review were to assess the magnitude and direction of associations among gender and acute coronary syndrome (ACS) symptom presentations, and to evaluate the potential role of the type of symptom-measurement strategy.

Methods

A systematic review of articles and dissertations from between 1966 and 2007 was performed. Effect sizes were calculated and meta-analyzed, using random-effects models.

Results

Gender differences of moderate or larger (ds=−.31 to −.68) magnitude were evident, and women were more likely than men to report back pain, palpitations, nausea/vomiting, and loss of appetite. For most symptoms, the magnitude of effects did not vary across different symptom-assessment strategies.

Conclusions

Our conclusions challenge those of some previous reviews in demonstrating substantive effects in the magnitude of gender differences in ACS symptoms that were consistent, irrespective of measurement approach. These data have implications for clinical practice, and suggest that gender-specific public-health campaigns targeting ACS symptoms may be warranted.