Table 1.
Summary of included studies.
| Author and date | Design type | Country and number of participants | Study aim | Results |
| Banks & Dracup (2007) | Quantitative observational study | USA 61 |
To identify gender differences in delay time and the reasons why African Americans delay in seeking medical care for the symptoms of acute MI. | Median delay time was 4.4 hours for women and 3.5 hours for men, although the difference was not significant. Women who were alone when symptoms began delayed longer than women who were with someone. |
| Dawson et al. (2023) | Quantitative observational study | Australia 256,901 |
To assess sex differences in epidemiology and care pathways from EMS contact through to clinical outcomes following discharge. | Women were less likely to receive guideline-directed care for transport to hospital, pre-hospital aspirin or analgesia administration, 12-lead ECG, IV cannula insertion and offload from EMS within target times. They were also less likely to undergo angiography or be admitted to cardiac unit. Long-term and 30-day mortality was also higher for women. |
| Hsu et al. (2021) | Quantitative observational study | Australia 110,044 |
To examine sex differences in the pre-hospital EMS care of patients hospitalised with MI. | Women were less likely than men to be assessed as having ACS (23% vs 28%). Women had 23% lower odds than men of receiving the MI protocol, 21% lower odds of receiving aspirin, 16% lower odds of receiving GTN and also 12% lower odds than men of having ECG performed. |
| Lewis et al. (2019) | Quantitative observational study | USA 2,814,041 |
To determine whether gender disparities exist in the pre-hospital management of chest pain or OHCA among patients who accessed the EMS. | Women with chest pain received a lower percentage of recommended treatments than men. Women were significantly less likely to be transferred using lights and sirens and they received fewer aspirin treatments than men. |
| Meisel et al. (2010) | Quantitative observational study | USA 683 |
To investigate the relationship between sex and the out-of-hospital treatment of patients with chest pain. | Women were less likely than men to receive aspirin, GTN or an IV. They were also less likely to receive treatments among the small sub-group of patients who were later diagnosed with MI. |
| Melberg et al. (2013) | Quantitative observational study | Norway 244 |
To understand why women with ST elevation tend to have longer treatment delays than men. | More women than men reported chest pain and discomfort in other areas of their body. Longer patient delays and system delays led to longer ischemic time in women. Women had a lower priority for an ambulance despite similar symptoms to men. |
| Muhrbeck et al. (2020) | Quantitative observational study | Sweden 539 |
To investigate the proportion of STEMI patients with a pre-hospital ECG within 10 minutes of ambulance arrival. | A pre-hospital ECG was obtained within 10 minutes for 29% of male patients and 14% of women patients. Women had a two-minute longer delay between ambulance arrival and ECG than men. They also had significantly longer patient delay. |
| O’Donnell et al. (2006) | Quantitative observational study | Ireland 890 |
To report the findings of a study that identified gender-specific pre-hospital care pathway delays amongst Irish women and men with MI. | Women are more likely to experience prolonged initial symptom onset to A&E delays and intense symptom onset to A&E delays. Advancing age, public patients and patients who arrived by any other admission route than driving themselves had pre-hospital delays. |
| Rothrock et al. (2001) | Quantitative observational study | USA 2858 |
To determine whether there is a gender bias in the pre-hospital management of patients with acute chest pain. | Male patients were more likely to receive aspirin and 12-lead ECGs compared to female patients. However, transport refusal, oxygen, nitro-glycerine and narcotic administration did not differ. |
A&E: accident and emergency; ACS: acute coronary syndrome; ECG: electrocardiogram; EMS: emergency medical services; GTN: glyceryl trinitrate; IV: intravenous; MI: myocardial infarction; OHCA: out-of-hospital cardiac arrest; STEMI: ST-segment elevation myocardial infarction.