Gender gaps in care: from the emergency room to heart procedures

Differences in research can turn into differences in care. This article looks at three well-studied settings: emergency chest pain, heart attack treatment times and a common heart valve procedure. It covers what the studies found and what they did not show.

Chest pain in the emergency room

A national study of emergency department visits for chest pain in adults 18 to 55 found women were less likely than men to be triaged as emergent (19.1% vs 23.3%) and to get an ECG (74.2% vs 78.8%). Women also waited longer to see a physician, independent of their clinical features.

A 2024 study of 186,840 visits at three emergency departments found white women were less likely than white men to be assigned the two highest triage levels, after adjusting for age, clinical factors and department conditions.

Time to treatment for heart attacks

In a study of heart attack patients, door-to-balloon time averaged 114.6 minutes for young women and 97.8 minutes for young men. The gap was not significant in older patients.

The evidence is mixed. A 2015 Spanish registry found longer waits for clot-dissolving drugs for women but no difference in door-to-balloon time.

A common heart valve procedure

A 2023 meta-analysis of 24 studies of transcatheter aortic valve replacement (TAVR), covering 92,499 patients, found women had about 1.8 times the risk of vascular complications compared with men. In an Asian registry, major vascular complications occurred in 5.5% of women and 1.8% of men.

Researchers tie this to smaller blood vessels and large delivery sheaths. Newer, lower-profile devices and more valve sizes have narrowed some gaps, and a 2018 analysis of the PARTNER II S3 study found no apparent sex differences in survival or stroke.

What this does not tell us

• These studies show differences, not their cause. The chest-pain study found the gap held independent of clinical features, so the reason is not shown.
• They do not show that any individual woman received worse care.
• Claims about triage software, or that tools were designed around male bodies, were not supported by the sources we checked, so they are not made here.

Frequently asked questions

Do women get slower emergency care for chest pain?

In one national study of adults 18 to 55, women were less likely than men to be triaged as emergent (19.1% vs 23.3%) and to get an ECG (74.2% vs 78.8%).

Do women wait longer for heart attack treatment?

In one study, door-to-balloon time averaged 114.6 minutes for young women and 97.8 minutes for young men. The difference was not significant in older patients, and other studies are mixed.

Why are vascular complications higher for women in TAVR?

Researchers tie it to smaller blood vessels and large delivery sheaths. A meta-analysis of 92,499 patients found about 1.8 times the risk for women.

Related reading

• Why women were left out of clinical trials, and what changed
• Do women need different drug doses? What the research says
• Women's health research funding: the gap in numbers
• How women entered medicine, and what doctors are still taught
• The women's health research gap: what the evidence shows
• Why women's health is decades behind: the research gap
• Dosed like a smaller man: why women get the wrong drug doses
• Why medicine is not one-size-fits-all for men and women

Sources

1. Banco D et al. Sex and race differences in the evaluation and treatment of young adults presenting to the emergency department with chest pain. Journal of the American Heart Association, 2022.
2. Patient sex, racial and ethnic disparities in emergency department triage. American Journal of Emergency Medicine, 2024.
3. Sex differences in symptom complexity and door-to-balloon time (VIRGO and SILVER-AMI). American Journal of Cardiology, 2023.
4. Influence of gender on transcatheter aortic valve implantation, meta-analysis. Reviews in Cardiovascular Medicine, 2023. Also sex differences in TAVR in Asia, 2021.
5. Spanish registry of heart attack patients, door-to-needle and door-to-balloon times by sex, 2015 (PMID 26121263).
6. Sex differences in the PARTNER II S3 transcatheter valve study, 2018 (PMID 29301644).

This article is for general education and is not medical advice. Sources were checked in October 2026. Several figures come from secondary analyses, as noted above.