Sex Differences in Symptom Phenotypes Among Older Patients with Acute Myocardial Infarction

Background Clinicians make a medical diagnosis by recognizing diagnostic possibilities, often using memories of prior examples. These memories, called exemplars, reflect specific symptom combinations in individual patients, yet most clinical studies report how symptoms aggregate in populations. We studied how symptoms of acute myocardial infarction combine in individuals as symptom phenotypes and how symptom phenotypes are distributed in women and men. Methods In this analysis of the SILVER-AMI Study, we studied 3041 patients (1346 women and 1645 men) ≥75 years old with acute myocardial infarction. Each patient had a standardized in-person interview during the acute myocardial infarction admission to document the presenting symptoms, which enabled a thorough examination of symptom combinations in individuals. Specific symptom combinations defined symptom phenotypes and distributions of symptom phenotypes were compared in women and men using Monte Carlo permutation testing and repeated subsampling. Results There were 1469 unique symptom phenotypes in the entire SILVER-AMI cohort of acute myocardial infarction patients. There were 831 unique symptom phenotypes in women, as compared with 819 in men, which was highly significant, given the larger number of men than women in the study (p Conclusions Older patients with acute myocardial infarction have enormous variation in symptom phenotypes. Women reported more symptoms and had significantly more symptom phenotypes than men. Appreciation of the diversity of symptom phenotypes may help clinicians recognize the less common phenotypes that occur more often in women.