Gender-based disparities in evidence-based care for patients admitted through Emergency Departments with acute coronary syndrome: A retrospective multi-site study

Dr Lisa Kuhn1,2,3, Dr Karen Page2, Dr Maryann Street1,2,3, Dr John Rolley2,4, Professor Julie Considine1,2,3

1Centre for Quality and Patient Safety Research, Deakin University, Geelong, Australia, 2School of Nursing and Midwifery, Deakin University, Geelong, Australia, 3Eastern Health – Deakin University Nursing and Midwifery Research Centre, Box Hill, Australia, 4University of Canberra, Canberra, Australia

Background. Evidence-based guidelines for acute coronary syndrome (ACS) reduce mortality and are gender-neutral. Timely access to evidence-based hospital ACS care begins in the emergency department (ED) and is provided through to patient discharge.

Aim. We evaluated if application of the Australian ACS evidence-based guidelines differed between women and men admitted to hospital through the ED.

Methods. Retrospective analysis of patient level data was undertaken for adults with ACS from three Australian public hospitals with EDs from 1.1.2013 to 30.6.2015.

Results. The study included 288 patient presentations, stratified by gender. Women were older than men (79 vs 75.5 years; p=0.009). In the ED, women received less urgent triage scores (58.3 vs 71.5%; p=0.026) than men and waited longer for their electrocardiographs (18.5 vs 15 mins; p=0.001). Women were proportionately less likely to be admitted to coronary care units (52.4 vs 65.3%; p=0.023) than men, more often being admitted to general medicine units instead (39.6 versus 22.9%; p=0.003). Although there was no statistical difference in the proportion of inhospital deaths between genders (p=0.286), the percentage of women (10.4%) who died was observed to be higher than for men (6.3%).

Conclusions. Maximising treatment for patients with ACS saves lives. We found differences in ACS care associated with gender from the time women arrived at ED triage that were not satisfactorily explained by patient level data. Further research needs to clarify reasons for these differences and whether they were appropriate or need to be improved. Our findings are guiding subsequent research through which we aim to reduce ACS practice variation between genders.


Dr Lisa Kuhn RN PhD is an emergency nurse and early career researcher who holds an Alfred Deakin Postdoctoral Research Fellowship.  During this 2-year research program she is developing a predictive model to decrease unwarranted practice variation in women’s heart attack management.  Heart disease is women’s leading killer and Lisa’s previous research has identified areas in early assessment and management in need of targeted strategies to improve quality and safety in patient care.

Lisa’s main research interests involve increasing equity in cardiovascular healthcare for women and disadvantaged groups through translating evidence into practice.  She uses quantitative, qualitative and mixed methods to research a broad range of issues including heart disease, emergency care and mental health.