The Development of a Chest-Pain Protocol for Women Presenting to the Emergency Department

Area of Science:

• Cardiology
• Public Health
• Health Equity

Background:

• Cardiovascular disease (CVD) is the leading cause of death for women globally and a major cause of premature death in Canada.
• Despite advances in cardiovascular care, CVD mortality and acute coronary syndrome (ACS) rates are rising in Canadian women.
• Women with ACS face worse outcomes due to misdiagnosis, delayed care, and underutilization of therapies, with Indigenous and racialized women disproportionately affected.

Purpose of the Study:

• To address the underrecognition, underdiagnosis, and undertreatment of CVD in women.
• To develop a novel chest pain assessment protocol for women experiencing acute symptoms.
• To improve the acute recognition and management of chest pain syndromes in women, considering sex and gender-specific factors.

Main Methods:

• Conducted a needs assessment and reviewed CVD risk factors and ACS pathophysiology through a sex and gender lens.
• Developed a unique chest pain assessment protocol using modified dynamic programming algorithmic methodology.
• Designed the protocol as a quick reference tool for emergency departments and acute-care settings.

Main Results:

• A novel algorithmic protocol for chest pain assessment in women was developed.
• The protocol aims to standardize and improve the accuracy of ACS diagnosis in women.
• It addresses the knowledge gap regarding unique symptoms and sex-and-gender specific risk factors in women.

Conclusions:

• CVD in women remains underrecognized, underdiagnosed, undertreated, and underresearched.
• Healthcare professionals' lack of awareness of sex-and-gender specific presentations contributes to outcome disparities.
• The new algorithmic protocol offers a potential solution for improving acute care and outcomes for women with chest pain.