The Influence of Gender on Evidence-Based Practice for Patients with Acute Coronary Syndrome: A Retrospective Multi-Site Australian Study

Abstract

Background: Death from acute coronary syndrome (ACS) is prevented with access to gender-neutral evidence-based guidelines. Evidence-based ACS care usually begins in the emergency department (ED) and should be provided through to patient discharge. Aim: We aimed to evaluate if ACS management was different in women and men admitted to hospital through EDs against Australian ACS evidence-based guidelines. Methods: We undertook retrospective analysis on patient level data for adults with ACS from three Australian public hospitals with EDs from 1 Jan 2013 to 30 June 2015. Results: The study included 288 eligible patients, stratified by gender. Women were older than men (79 vs 75.5 years; p = 0.009). In the ED, women received less urgent triage scores (58.3 vs 71.5%; p = 0.026) than men and waited longer for their electrocardiographs (18.5 vs 15 mins; p = 0.001). Women were less likely to have been admitted to coronary care units (52.4 vs 65.3%; p = 0.023), instead, more often admitted to general medicine units (39.6 versus 22.9%; p = 0.003) than men. Although there was no statistical difference in the proportion of inhospital deaths between genders (p = 0.286), the percentage of women (10.4%) who died was observably higher than that for men (6.3%). Conclusions: Maximising treatment for patients with ACS saves lives. We found several differences in ACS care by gender that were not explained satisfactorily by patient level data. Further research needs to clarify reasons for these gender differences and whether they can or should be reduced. Our findings are guiding subsequent research through which we aim to reduce ACS practice variation between genders.