To the Editor,

We are gratefeul for the comments of Vidal-Pérez et al. with respect to sex inequalities in the management of atrial fibrillation, which highlight the true extent of this problem in Spain.1, 2 Inequalities can also be seen in the emergency treatment of other cardiovascular diseases in this country. For example, a recent multicenter study has shown that, despite the fact that the treatment of heart failure in the emergency room is similar in men and women, the latter are less commonly admitted to cardiology units.3

With respect to patients presenting at the emergency room with chest pain, significantly fewer women aged 71-80 years are admitted to intensive/intermediate care units, and stress tests are requested significantly less often for women aged 81-90 years.4 With respect to ST segment elevation acute myocardial infarction, it has been noted that the delay for women to present at a hospital is longer, and that the time between arrival and undergoing ECG is longer.5 The subtle differences made manifest by the above studies are difficult to justify in terms of any sex difference in the pattern of disease presentation or required treatment.

.

Corresponding author: bcvinent@clinic.ub.es