Sex Differences in Acute Coronary Syndromes: A Scoping Review Across the Care Continuum

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 dif...

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Main Authors: Anna Marzà-Florensa, Pauline Kiss, Dina Mohamed Youssef, Sara Jalali-Farahani, Fernando Lanas, Mariachiara di Cesare, José Ramón González Juanatey, Sean Taylor, Alicia Uijl, Diederick E. Grobbee, Sarah Des Rosiers Rosiers, Pablo Perel, Sanne A. E. Peters
Format: Article
Language:English
Published: Ubiquity Press 2025-03-01
Series:Global Heart
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Online Access:https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1410
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author Anna Marzà-Florensa
Pauline Kiss
Dina Mohamed Youssef
Sara Jalali-Farahani
Fernando Lanas
Mariachiara di Cesare
José Ramón González Juanatey
Sean Taylor
Alicia Uijl
Diederick E. Grobbee
Sarah Des Rosiers Rosiers
Pablo Perel
Sanne A. E. Peters
author_facet Anna Marzà-Florensa
Pauline Kiss
Dina Mohamed Youssef
Sara Jalali-Farahani
Fernando Lanas
Mariachiara di Cesare
José Ramón González Juanatey
Sean Taylor
Alicia Uijl
Diederick E. Grobbee
Sarah Des Rosiers Rosiers
Pablo Perel
Sanne A. E. Peters
author_sort Anna Marzà-Florensa
collection DOAJ
description 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: A systematic literature search was conducted in Pubmed, EMBASE, and the World Health Organization Global Index Medicus. The search was restricted to original research articles published between January 1, 2013, and August 30th, 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.
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spelling doaj-art-ad2b0287f20641bdb16f17df5bdf166c2025-08-20T02:17:29ZengUbiquity PressGlobal Heart2211-81792025-03-01201262610.5334/gh.14101391Sex Differences in Acute Coronary Syndromes: A Scoping Review Across the Care ContinuumAnna Marzà-Florensa0https://orcid.org/0000-0003-0338-4292Pauline Kiss1https://orcid.org/0000-0002-3654-4881Dina Mohamed Youssef2https://orcid.org/0000-0002-7623-5733Sara Jalali-Farahani3https://orcid.org/0000-0003-4905-0191Fernando Lanas4https://orcid.org/0000-0003-3595-9759Mariachiara di Cesare5https://orcid.org/0000-0002-3934-3364José Ramón González Juanatey6https://orcid.org/0000-0001-9681-3388Sean Taylor7https://orcid.org/0000-0002-5031-3588Alicia Uijl8https://orcid.org/0000-0003-2835-7741Diederick E. Grobbee9https://orcid.org/0000-0003-4472-4468Sarah Des Rosiers Rosiers10Pablo Perel11https://orcid.org/0000-0002-2342-301XSanne A. E. Peters12https://orcid.org/0000-0003-0346-5412Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, UtrechtGlobal Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, UtrechtGlobal Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, UtrechtInstitute of Public Health & Wellbeing, University of EssexUniversidad de La FronteraInstitute of Public Health & Wellbeing, University of EssexUniversity Hospital, Santiago de CompostelaWorld Heart Federation, GenevaGlobal Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht; Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, NL; Division of Cardiology, Department of Medicine, Karolinska Institutet, StockholmGlobal Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, UtrechtThe Novartis Foundation, BaselWorld Heart Federation, Geneva, CH; Department of Non Communicable Disease Epidemiology, London School of Hygiene & Tropical MedicineGlobal Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, NL; The George Institute for Global Health, School of Public Health, Imperial College London, London, UK; The George Institute for Global Health, University of New South Wales, Sydney, New South WalesIntroduction: 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: A systematic literature search was conducted in Pubmed, EMBASE, and the World Health Organization Global Index Medicus. The search was restricted to original research articles published between January 1, 2013, and August 30th, 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.https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1410acute coronary syndromesex differencesglobal healthcardiovascular diseaseprehospital carediagnosis
spellingShingle Anna Marzà-Florensa
Pauline Kiss
Dina Mohamed Youssef
Sara Jalali-Farahani
Fernando Lanas
Mariachiara di Cesare
José Ramón González Juanatey
Sean Taylor
Alicia Uijl
Diederick E. Grobbee
Sarah Des Rosiers Rosiers
Pablo Perel
Sanne A. E. Peters
Sex Differences in Acute Coronary Syndromes: A Scoping Review Across the Care Continuum
Global Heart
acute coronary syndrome
sex differences
global health
cardiovascular disease
prehospital care
diagnosis
title Sex Differences in Acute Coronary Syndromes: A Scoping Review Across the Care Continuum
title_full Sex Differences in Acute Coronary Syndromes: A Scoping Review Across the Care Continuum
title_fullStr Sex Differences in Acute Coronary Syndromes: A Scoping Review Across the Care Continuum
title_full_unstemmed Sex Differences in Acute Coronary Syndromes: A Scoping Review Across the Care Continuum
title_short Sex Differences in Acute Coronary Syndromes: A Scoping Review Across the Care Continuum
title_sort sex differences in acute coronary syndromes a scoping review across the care continuum
topic acute coronary syndrome
sex differences
global health
cardiovascular disease
prehospital care
diagnosis
url https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1410
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