LAUSR

Since recognition of differences between men and women’s outcomes from acute coronary syndromes (ACS) more than two decades ago, many researchers have investigated possible reasons. Attention has focused on physiological causes and on differences in management after a diagnosis is made (eg, women are less likely to be referred for cardiac catheterisation and percutaneous coronary interventions).1 Investigators have also examined upstream processes: patient-related factors, such as symptom characteristics,2 symptom recognition and treatment-seeking delay,3 which can prolong time-to-treatment, and system-related factors, such as health professionals’ clinical decision-making,4 have been studied extensively. A focus on the critical first minutes and hours after presentation to an emergency department (ED) with symptoms of ACS is particularly relevant since the processes and decisions undertaken during this time shape the clinical trajectory on which patients with symptoms of ACS travel. Mnatzaganian5 and colleagues report a retrospective, 5-year, population-based study of patients presenting to three EDs in Melbourne, Australia, with a main or secondary complaint of non-traumatic chest pain (n=76 216 presentations). The investigators examined sex differences in four aspects of care: (1) urgency score assigned by triage nurses; (2) time-to-examination by an ED physician; (3) troponin testing; (4) admission to a specialty unit, as well as in-hospital mortality. Multivariable models were constructed that adjusted for symptoms; arrival mode, time and day of week; main presenting symptom and triage score; diagnosis of myocardial infarction; comorbidities; other acute conditions associated with the chest pain presentation (eg, cardiac arrest, respiratory distress); whether admitted to the hospital; type of admission unit and a ‘relative index of inequality’, derived from postal code–based socioeconomic status. For each outcome, models for two age categories (18–54 years and 55 years and older) were constructed separately. The investigators found that for every outcome examined, …