Gender differences in the management of acute coronary syndrome patients: One year results from HPIAR (HP-India ACS Registry)

Data from high-income countries suggest that women receive less intensive diagnostic and therapeutic management than men for acute coronary syndrome (ACS). There is a paucity of such data in the Indian population, which is 69% rural and prior studies focused mostly on urban populations. The objective of the present study was to identify the gender based differences in ACS management, if any, in a predominantly rural population. Data from 35 hospitals across Himachal Pradesh covering > 90% of state population were collected for one year (July 2015–June 2016). A total of 2118 ACS subjects met inclusion criteria and baseline characteristics, in-hospital treatments and mortality rates were analyzed. Women constituted less than one-third of ACS population. Women were older compared to men and were more likely to present with NSTEMI/UA. Misinterpretation of initial symptoms and late presentation were also common in women. Fewer women received optimal guideline based treatment and PCI (0.9% vs 4.2%, p < 0.01). Compare to men, women more often had Killip class > 1 (27.3% vs 20.4%, p < 0.01) and higher in-hospital mortality (8.5% vs 5.6%, p = 0.009). On multivariate analysis the association between female gender and mortality was attenuated (adjusted odds ratio [OR] = 1.36 [0.77–2.38]). The present study from India, is the first of its kind to evaluate the gender based differences among ACS patients, in a predominantly rural population. Our analysis demonstrates a significant gender based difference between symptom awareness and delay in presentation, management and in-hospital outcome. Further studies are warranted across other parts of country to investigate this gender disparity.