Community-based gender perspectives of triage and treatment in suspected myocardial infarction.
BACKGROUND
The gender perspectives of the triage of acute coronary syndromes (ACS) in a community are insufficiently explored.


METHODS
Patients (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).


RESULTS
Women 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 1: Patients 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 2: Patients 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 3: Patients 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.


CONCLUSIONS
In our practice setting, men are given priority over women in admission to CCU, but no gender differences are seen thereafter.
Institution of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
A
A
Ravn-Fischer
K
K
Caidahl
M
M
Hartford
T
T
Karlsson
S
S
Kihlgren
E
E
Perers
H
H
Rashed
P
P
Johanson
J
J
Herlitz
D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012111:Residence Characteristics; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014218:Triage / Q000379:methods / Q000592:standards*