Female sex is associated with widespread unfavorable disparities in acute coronary syndrome management, with 45% of care outcomes favoring men compared to only 5% favoring women.
Systematic Review (n=32,875,226)
This global scoping review highlights pervasive sex disparities in ACS care, predominantly disadvantaging women, particularly in the early phases of pre-hospital care and diagnosis.
Effect estimate: 45% favored men, 5% favored women, 50% mixed or no difference
Introduction: Optimal diagnosis and management of acute coronary syndrome (ACS) is essential to improve clinical outcomes and prognosis. Sex disparities in ACS care have been reported in the literature, but evidence gaps remain. This review aims to map and to summarize the global evidence on sex differences in the provision of care across the ACS continuum. Methods: , 2023, and with a full-text available in English, Spanish, Dutch, or French. The search terms and key words covered five aspects of the ACS care continuum: pre-hospital care, diagnosis, treatment, in-hospital events, and discharge. Results: Of the 15,033 identified articles, 446 articles (median percentage of women per study: 29%), reporting on 1,483 outcomes, were included. Most studies were conducted in high-income regions (65%). Studies reported on pre-hospital care (8%), diagnosis (9%), treatment (45%), discharge (14%) and events (24%). For 45% of outcomes, results favored men, 5% favored women, and 50% showed mixed results or no sex difference. ACS care aspects with the largest sex differences were pre-hospital care (58% of the outcomes favored men vs 7% favored women) and diagnosis (70% favored men vs 2% favored women). Conclusion: Studies on sex differences in ACS mainly come from high-income regions. Sex differences in ACS management are widely reported and mainly unfavorable to women, especially in the early phases of pre-hospital care and diagnosis.
Florensa et al. (Tue,) conducted a systematic review in Acute coronary syndrome (n=32,875,226). Female sex vs. Male sex was evaluated on Direction of sex differences in ACS care outcomes (45% favored men, 5% favored women, 50% mixed or no difference). Female sex is associated with widespread unfavorable disparities in acute coronary syndrome management, with 45% of care outcomes favoring men compared to only 5% favoring women.