Gender-Based Delays in Acute Coronary Syndrome and Their Impact on Outcomes

BackgroundCardiovascular disease (CVD) is the leading cause of death in the United States, but the importance of gender differences in the prevalence and burden of various CVD has only been acknowledged since the mid-eighties. 8 Beyond the basic description and quantification of these gender differences, some researchers have attempted to identify bias and develop hypotheses related specifically to gender-specific CVD treatment and outcomes.One of the physicians at the forefront of this research was Dr. Bernadette Healy, who in 1991 was the first to present on Yentl Syndrome, which suggested gender bias in coronary A B S T R A C TCardiovascular disease (CVD) remains the leading cause of death in the United States, with gender disparities in presentation and outcomes increasingly recognized.Women with acute coronary syndrome (ACS) often experience atypical symptoms and are subject to care-seeking delays, potentially contributing to poorer prognoses.This literature review aimed to evaluate the extent of treatment delay in female patients with ACS and to assess its relationship with clinical outcomes.Using a structured search of the PubMed database, 14 articles published in the past decade were initially identified, with 11 meeting inclusion criteria following relevance screening.Among the selected studies, five reported statistically significant delays in treatment for women compared to men, with women more likely to present later after symptom onset and experience additional in-hospital delays.These delays were associated with increased short-term mortality, with one study reporting a twofold increase in 30-day mortality among women.Conversely, five studies did not find statistically significant differences, though several showed trends toward longer delays in women.Variability in findings may be attributed to small sample sizes or improved public awareness of sex-specific ACS symptoms in recent years.Several studies identified atypical symptom perception, lack of symptom recognition, and social factors as key contributors to delayed care-seeking behavior among women.Interviews with female patients revealed that many did not perceive their symptoms as consistent with myocardial infarction, leading to delayed presentation.These findings highlight the continued presence of gender-based disparities in ACS treatment and outcomes.Efforts to educate both patients and healthcare providers about atypical symptomatology in women, as well as system-level interventions to reduce delays, may improve timely care and reduce mortality.Further research is needed to better understand modifiable barriers to prompt treatment in women and to design targeted strategies that address these gaps.