Gender-Based Disparities in the Evaluation and Management of Acute Coronary Syndromes

Cardiovascular disease remains one of the leading causes of mortality globally. Disparities in identifying the presence of cardiovascular disease during clinical evaluation between men and women are likely to contribute to high morbidity and mortality rates, especially in the emergency department setting. Specifically, compared with their male counterparts, women tend to present with atypical and non-specific symptoms, which may lower clinical suspicion and lead to significant delays in diagnosis, especially in obtaining an electrocardiogram (ECG). In addition, women often demonstrate lower help-seeking behaviors when symptoms occur, slowing their initial presentation to the emergency department, which may be influenced by a fear of dismissal, even when their presenting symptoms are typical of those reported by men. Multiple delays in diagnosis can have compounding effects on treatment, which may lead to a longer time to revascularization when needed after the onset of symptoms. These multifactorial delays have been shown to be associated with adverse outcomes unique to women, including higher complication rates, longer hospital stays, and poorer short-term outcomes. Contributing factors associated with these delays may involve a confluence of factors, including but not limited to the historical lack of cardiovascular research focused on women, limited symptom recognition among both patients and clinicians, and the potential influence of bias in clinical decision-making. Addressing these factors should begin with standardized emergency department triage protocols that incorporate symptom recognition specific to men and women, which will aid in prompt ECG acquisition when necessary. Standardized training to increase awareness of the differences in presentation of cardiovascular disease among men and women is warranted. In addition, further research efforts are necessary to achieve meaningful improvements in timely, evidence-based cardiovascular care for women. These disparities are likely multifactorial, reflecting the relationship between the differences in symptom presentation, comorbidity burden, healthcare access, and system-level processes, rather than any single causal factor.