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

Document Type


Peer Reviewed


Publication Date


NLM Title Abbreviation

Heart Lung

Journal/Book/Conference Title

Heart & lung

PubMed ID


DOI of Published Version



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.


Acute Coronary Syndrome/diagnosis/epidemiology/nursing/pathology, Appetite, Back Pain, Chest Pain, Confidence Intervals, Diagnosis, Differential, Female, Humans, Male, Neck Pain, Sex Factors, Shoulder Pain, United States/epidemiology

Published Article/Book Citation

The definitive version was published in Heart & lung, 39:4 (2010) pp.283-295. DOI:doi:10.1016/j.hrtlng.2009.10.010.

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