background: Heart disease is the leading cause of death for women in the United States.National estimates found that compared to white women, African American women have higher acute myocardial infarction (AMI) hospitalization rates and those discharged with AMI have a higher prevalence of hypertension, diabetes, and heart failure.

purpose: Characterize patients discharged with an AMI from four community hospitals and investigate the care pathways female patients receive in the Emergency Department (ED).

methods: We conducted a retrospective cohort study of all adult patients discharged with an AMI between October 2015 and March 2018. Additionally, we performed a retrospective chart review of adult female patients who came to the ED with a chief complaint suggestive of a cardiac event and compared their care pathways to age- and race-matched male controls.

results: Approximately 60% of the 3,729 AMI cases were male, and on average,significantly younger than females (72 vs 78, p-value=<0.001). Only 50% of females and 53% of males under 50 received orders for a cardiac consult. Among female cases under 50, 8% were African Americanand 2% were white (p-value=<0.001). Compared to white women under 50, African American women under 50 had higher rates of hyperlipidemia (50% vs 40%), hypertension (59% vs 40%), acute renal failure (27% vs 16%), and type 2 diabetes (41% vs 16%).

conclusion: Our results suggest the need for greater provider surveillance of African American women under the age of 50 presenting with symptoms of a cardiac event in the ED.