Community-based gender perspectives of triage and treatment in suspected myocardial infarction

BackgroundThe gender perspectives of the triage of acute coronary syndromes (ACS) in a community are insufficiently explored.MethodsPatients (n = 3224) with symptoms of ACS, in whom ECG was sent by the ambulance crew to a coronary care unit (CCU)/ cath lab, were investigated in the municipality of Göteborg in 2004–2007. Background, triage priority, investigations and treatment were analysed (p-values age adjusted) in relation to gender. Data were compared with three published studies (1995–2002: Surveys 1–3).ResultsWomen were directly admitted to the CCU significantly less frequently than men (23 versus 35%, p < 0.0001). Adjusted for ECG findings, age, symptoms and medical history, odds ratio and 95% confidence limits (for direct admission; men versus women) were 0.61; 0.46–0.82.Survey 1Patients with ACS, aged < 80, in CCU at a university hospital (n = 1744). Only minor differences between women and men, with regard to investigations and treatment, were found.Survey 2Patients discharged from hospital (dead or alive) with AMI, regardless of type of ward (n = 1423). Fewer women than men were admitted to CCU and fewer women underwent coronary angiography (21% versus 40%; p = 0.02) and coronary revascularisation (12% versus 27%; p = 0.004).Survey 3Patients with symptoms of AMI (n = 930) and patients with a confirmed AMI (n = 130) from a pre-hospital perspective. Women tended to be given lower priority than men both by the ambulance dispatchers and by the ambulance crew.ConclusionIn our practice setting, men are given priority over women in admission to CCU, but no gender differences are seen thereafter.