Sex differences in care for acute coronary syndrome in patients under 60 years: Primary care presentation, referral patterns, hospitalizations and clinical outcomes

OBJECTIVES: Acute coronary syndrome (ACS) incidence and mortality rates have risen among women <60 years. This study sought to examine sex differences in healthcare pathways for first-time ACS in young patients, focusing on pre-ACS care, diagnosis and in-hospital management, and post-discharge outcomes. STUDY DESIGN: Observational cohort study. METHODS: This study uses linked data from primary care, hospital records and national mortality datasets to assess ACS care pathways among Dutch patients aged 30-60 years between 2013 and 2022. Continuous variables were compared with Wilcoxon rank-sum tests and categorical variables with Chi-square tests. Multiple testing is addressed by controlling the false discovery rate. RESULTS: Women more often had at least one comorbidity (57.6 % vs 51.3 %, p = 0.024) and more primary care consultations in the month preceding ACS (1.37 vs 1.00, p < 0.001). Men were more frequently diagnosed with ST-elevation myocardial infarction (STEMI), while women were more often diagnosed with non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA), p < 0.001. In-hospital interventions were similar between sexes for STEMI but were different and less frequently performed in women with NSTEMI (p = 0.001) or UA (p = 0.005) compared with men. Post-discharge, women were less likely to receive antithrombotic (87.7 % vs 91.5 %, p = 0.024) and lipid-lowering therapies (82.6 % vs 88.5 %, p = 0.002). Mortality rates before hospitalization, at 30 days, and at 1 year were comparable between sexes. CONCLUSIONS: Sex differences exist in healthcare pathways for individuals aged 30-60 years with first-time ACS regarding prevalence of comorbidities, ACS subtype, in-hospital interventions, and post-discharge medication use. However, 30-day and 1-year survival rates after discharge were comparable between women and men.