Abstract Body (Do not enter title and authors here): Introduction: Patients presenting to the emergency department (ED) with chest pain are frequently admitted to inpatient or observation units. We sought to assess gender, racial, and ethnic variations in the care of chest pain patients presenting to the ED.

Methods: A retrospective chart review of patients presenting to UF Health Shands ED from 6/2019–12/2023 with chest pain was conducted. We included patients with high-sensitivity troponin I levels below the 99^th percentile (<15 ng/L for women and <20 ng/L for men) and moderate or high HEART score (4-6 and 7+, respectively). HEART score was determined at initial presentation. We analyzed the type of ED dispositions based on gender, race, and ethnicity. Negative predictive value (NPV) was calculated for the composite outcome of myocardial infarction (MI) and cardiovascular death or death from unknown cause within 30 days.

Results: We included 1329 patients (52.7% women). Black represented 24.8% of patients, American Indian or Alaska Native 0.4%, Asian or Pacific Islander 1.1%, and white 67.7%. Hispanic or Latino represented 6.9% of patients. The proportion of patients admitted to the hospital or observation unit was lower in women than men (25.7% vs 30.7%; p=0.0002). Black patients were less likely to be admitted or observed compared to white (22.7% vs 30.3%; p= 0.006). Similarly, Hispanic or Latino patients were less likely to be admitted to the hospital or observation unit (20.7% vs 28.6%; p=0.04). There were 2 MIs and 1 death in the cohort, with 2 of these events being women but no events in black or Hispanic or Latino patients. The NPV for troponin levels below the 99^th percentile for our composite outcome was 99.8% in the cohort overall, 99.7% in women, 99.8% in men, 99.7% for white, 100% for black, and 100% for Hispanic or Latino patients.

Conclusions: Among patients with chest pain presenting to the ED with moderate or high HEART score but troponin levels below the 99^th percentile, women, black, and Hispanic or Latino patients were less likely to be admitted to the hospital or observation unit. Despite these disparities, outcomes at 30 days were similar compared to other groups, and high-sensitivity troponin performed well across all groups.