Sex- and Gender-Related Disparities in the Management of Acute Coronary Syndrome: A Mixed-Methods Study

Aims. This study aimed to understand gender differences in the management and treatment of acute coronary syndrome in patients treated at the emergency and cardiology departments of a university hospital in Spain. Methods. A descriptive mixed-methods study was conducted, including both quantitative and qualitative phases. Data from patients diagnosed with ACS between 2016 and 2021 were analyzed. Interviews were conducted with patients and physicians to understand their perceptions and experiences. Results. This study included 478 patients, 70.51% men and 29.49% women. Men were younger on average than women (66.43±12.79 vs. 72.54±13.94 years, p<0.001). Tobacco was the most common risk factor. Men with acute coronary syndrome with high segment T presented with elevated enzymatic markers. Women were found to have a greater delay in seeking medical help and received fewer pharmacological treatments and revascularization procedures than men did. According to the multifactorial analysis, fibrinolysis and angioplasty were performed more often in men. Despite similar symptomatology, differences were found in physicians’ perceptions of severity. Conclusions. Although symptomatology is similar between men and women, there are differences in the management and treatment of acute coronary syndrome. These findings suggest the influence of psychosocial factors in women's delay in seeking medical help, as well as gender biases in physicians' perceptions of severity. These results have important implications for improving equity in the care of patients with acute coronary syndrome.