Document Type


Publication Date



There are sex and race differences in many aspects of health care delivery. For example, blacks and women are less likely to receive aspirin and thrombolytic drugs. Blacks and women presenting with chest pain are less likely to be referred for cardiac catheterization. Blacks and women diagnosed with acute myocardial infarction (AMI) are also less likely to undergo cardiac catheterization. The gender differences in diagnostic evaluation after AMI appear more pronounced among younger women. The American College of Cardiology and the American Heart Association joint electrocardiography guidelines state that all patients presenting to the emergency department (ED) with chest pain should undergo electrocardiography (ECG) to rule out acute ischemia or infarction, regardless of sex or age. It is possible that sex and race differences exist in the administration of this important screening tool among patients with chest pain, possibly reflecting a lower suspicion of coronary heart disease in women (especially young women) and blacks. These management differences may result in failure to diagnose coronary heart disease and may explain why these subgroups are referred less often for cardiac catheterization. Therefore, the purpose of this study was to examine whether this basic guideline is being implemented uniformly in a national sample of patients presenting to the ED with chest pain. Specifically, we hypothesized that young women and blacks presenting with chest pain would be significantly less likely to undergo ECG relative to their white male counterparts.


Originally published:

Arnold, Amy L., Milner, Kerry, Vaccarino, Viola. "Sex and Race Differences in Electrocardiogram Use (The National Hospital Ambulatory Medical Care Survey)." The American Journal of Cardiology 88.9 (2001): 1037-1040.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.