Effect of gender on evidence-based practice for Australian patients with acute coronary syndrome : A retrospective multi-site study

Background
Early acute coronary syndrome (ACS) care occurs in the emergency department (ED). Death and disability from ACS are reduced with access to evidence-based ACS care. In this study, we aimed to explore if gender influenced access to ACS care.

Methods
A retrospective descriptive study was conducted for 288 (50% women, n = 144) randomly selected adults with ACS admitted via the ED to three tertiary public hospitals in Victoria, Australia from 1.1.2013 to 30.6.2015.

Results
Compared with men, women were older (79 vs 75.5 years; p = 0.009) less often allocated triage category 2 (58.3 vs 71.5%; p = 0.026) and waited longer for their first electrocardiograph (18.5 vs 15 min; p = 0.001). Fewer women were admitted to coronary care units (52.4 vs 65.3%; p = 0.023), but were more often admitted to general medicine units (39.6 vs 22.9%; p = 0.003) than men. The median length of stay was 4 days for both genders, but women were admitted for significantly more bed days than men (IQR 3–7 vs 2–5; p = 0.005).

Conclusions
There were a number of gender differences in ED care for ACS and women were at greater risk of variation from evidence-based guidelines. Further research is needed to understand why gender differences exist in ED ACS care.