Women Wait Longer Than Men For First Ekg When Self-Presenting With Suspected Acute Coronary Syndrome, A Review Of The Irish National Acs Registry

Introduction: Women suffer longer delay times until diagnosis and treatment when presenting with ACS, despite cardiovascular disease being the biggest cause of death amongst women. European guidelines recommend that women and men with suspected ACS are managed according to a common protocol. We aimed to investigate whether differential system delay existed for women versus men due to longer wait time for initial EKG testing in patients who self-presented to the emergency room with suspected ACS, bypassing the pre-hospital diagnosis and warning system Methods: We retrospectively reviewed the Irish national ACS registry and identified all cases of patients who self-presented to the emergency room between 2013-2018. Those patients for whom accurate time delays were not recorded were excluded. Baseline characteristics were compared for both groups. We determined the wait time from presentation to first EKG for both groups and performed a Mann-Whitney U test to test the difference between the groups. Results: Total number of self-presenters was 714 (women 154, men 560), representing 13.2% of all patients in the registry. We excluded 54 due to inaccurate time recordings; 14 were excluded due to first EKG performed by a family doctor in the community. Women were older than men (mean age 66.3 vs. 59.2yrs, P=0.0000012) and had similar rates of diabetes mellitus (10.4% vs. 11.9%, P=0.63). More women were current smokers (45.4% vs. 37.3%, P=0.11), more likely to be hypertensive (58.5% vs 44.5%, P=0.002) and have a diagnosis of hyperlipidaemia (56.7% vs. 46.8%, P=0.048). Median wait times were longer for women compared with men: 25.0 min (IQ 13-74) vs. 18.0 min (IQ 8-42)( P=0.002)(see Figure). Conclusion: Women self-referring with suspected ACS to the emergency room had longer wait times for their first EKG compared with men despite being more likely to have an elevated cardiovascular risk factor profile. Differential wait times for EKG is an important contributor to system delay.