Differences in the treatment and evolution of acute coronary syndromes according to gender: what are the causes?

Aims and objectivesThe objectives of this study were to analyse the differences in the treatment and the evolution of acute coronary syndromes according to the gender of the patient and to determine the likely causes of these differences. BackgroundEpidemiological studies confirm the differences in the course and treatment of acute coronary syndromes according to factors such as gender and age. The factors associated with the observed gender-based differences are not known. Design and methodsThis prospective study was conducted on 596 patients treated in the Hospital Emergency Service of the Hospital Complex of Navarra, Spain, from 1 January 2012 to April 2013 with acute coronary syndromes. A bivariate and logistic analysis has been made by adjusting the age and severity of process to know the differences by gender. ResultsA total of 718% (n=428) were men, and the remaining 282% (168) were women. The mean age of the men was 664127years, and the mean age of the women was 725139years. We found that antiplatelet drugs (684 vs. 227%), blockers (70 vs. 254%), ACE inhibitors (562 vs. 156%), fibrinolysis (172 vs. 45%, p=0025) and primary angioplasty (AP) (387 vs. 163%, p=0008) were less frequently administered to women compared with men. We observed an additional delay in the demand for health care in women with acute coronary syndromes compared with men. ConclusionsThere is an association between treatment differences and gender. The delay in the request of health care in women is observed to be the largest correlating factor, in addition to voluntary discharge in women affected by acute coronary syndromes. Relevance to clinical practiceDelays in seeking medical care or voluntary discharge are likely factors related to worse outcomes in women. These factors should be explored, and the results should be made available to the public, particularly to women.