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Sex & Gender Hot Off the Press: Sex and Gender Journal Club
Hot Off the Press: Sex and Gender Journal Club
By Angela Jarman, MD, MPH; Basmah Safdar, MD; Tracy Madsen, MD, PhD; and Alyson McGregor, MD, MA on behalf of the SAEM Sex and Gender in Emergency Medicine Interest Group
Incorporating sex and gender evidencebased medicine into your practice is critical to achieving an equitable and precise practice.
High sensitivity (hs) troponin assays are now Food and Drug Administration (FDA) approved and in wide usage in the United States. In the High STEACS study, investigators found that the use of sex-specific high sensitivity troponin assays increased the diagnosis of myocardial infarction in women by 25%, however women remained less likely to receive evidence-based interventions. Use of this sex-specific threshold did not translate to a difference in clinical outcomes at one year and thus is deserving of further study to elucidate whether this is due to pathophysiologic differences or disparities in care by sex. Another recent study from the Korean Heart Failure Registry found that pro-B type natriuretic peptide (BNP) is more predictive of major adverse cardiac event (mace) in men than in women. This study also found that pro-BNP levels are higher in women due to the influence of estrogen. Finally, the VIRGO investigators found that women with myocardial infarction were more likely
than men to present with greater than three symptoms and were more likely to perceive their symptoms as stress/ anxiety.
Sex differences also persist in the care of neurovascular emergencies, specifically in stroke care. A recent meta-analysis found a persistent disparity in that women are less likely to receive IV thrombolysis, even in controlled analysis; the magnitude of this disparity has decreased in recent years. Related, a new study found that women and Black patients are also more likely to decline thrombolytics, leading one to question the role of patient/provider dyads in discussing this treatment option. The DOUBT study group found that women are more likely to be diagnosed with stroke mimics, and less likely to have their diagnoses revised even in light of imaging demonstrating ischemia. Lastly, an important study of pregnant women with stroke found that endovascular thrombectomy was successful with minimal complications. ABOUT THE AUTHORS
Dr. Jarman is assistant professor of emergency medicine and director of the Sex and Gender in Emergency Medicine Program at the University of California, Davis
Dr. Alyson J. McGregor is professor of emergency medicine and associate dean of Clinical Faculty Affairs and Development at the University of South Carolina School of Medicine Greenville. @amcgregormd
Dr. Safdar is associate professor of emergency medicine and vice chair for faculty affairs and development, in the department of emergency medicine at Yale School of Medicine. She is also director of Yale New Haven Hospital Chest Pain Center.
Dr. Madsen is associate professor of emergency and associate director of the Sex and Gender in Emergency Medicine Program at The Warren Alpert Medical School of Brown University. She is also codirector of the Comprehensive Stroke Center, Rhode Island Hospital.
About the SGEM IG
The Sex and Gender in Emergency Medicine (SGEM) Interest Group works to raise consciousness within the field of emergency medicine on the importance patient sex and gender have on the delivery of emergency care and to assist in the integration of sex and gender concepts into emergency medicine education and research. Membership in SAEM's academies and interest groups is free. To participate in one more groups: 1.) log into SAEM.org; 2.) click “My Participation” in the upper navigation bar; and 3) click “Update (+/-) Academies or Interest Groups.”
