1359: Patient‘s perceptions of prehospital care during acute myocardial infarction

Abstract

Purpose: Prompt treatment of acute coronary syndromes (ACS) was shown to reduce morbidity and mortality. Gender differences in ACS symptoms are well documented, but the findings regarding how differently men and women may respond to ACS symptoms are less consistent; such responses influence health seeking behavior and subsequent outcomes. The purpose of this study was to explore gender differences in the cognitive, emotional and behavioral responses to ACS symptoms in Lebanese adults. Methods: A convenience sample of 149 men and 63 women diagnosed with unstable angina or acute myocardial infarction (MI) were interviewed within 72 h of admission to coronary care in a tertiary center in Beirut. The instrument used was the Response to Symptoms Questionnaire. Data was also extracted from the medical records about demographic and clinical variables. Results: Women were older (p < 0.01), less educated (p < 0.001), and more often widowed (p < 0.001) than men, but did not differ in their medical diagnosis. In terms of cardiovascular risk factors, women were more likely to be hypertensive (p < 0.05), but less likely to be current smokers (p < 0.01) than men. Women also had higher HDL (48.02T 10.50 vs. 40.87 T 13.36, p < 0.001), lower triglycerides level (172.88 T 91.30 vs. 217.22 T 141.15, p <0.05), and fewer diseased vessels (1.57 T 1.13 vs. 2.00T 1.10, p <0.05) than men. Women were more likely to have shoulder pain (OR = 2.01, CI = 1.03-3.93), dyspnea (OR = 1.92, CI = 1.06-3.49), nausea and vomiting (OR = 2.32, CI = 1.2-4.49), and palpitations (OR = 4.15, CI = 1.6-10.73) than men, and rated the symptoms as more severe (8.5 T 1.88 vs. 6.22 T 2.29, p = 0.01). Women experienced the symptoms more often at home (p < 0.01) and in the company of family members (p < 0.001) compared to men. Knowledge of MI symptoms was lower in women than men (p = 0.034). Women also showed a trend of feeling more fear, more embarrassment to seek help, less willingness to trouble others, and longer delay in coming to the hospital compared to men (0.05 < p < 0.1). Conclusion: The different clinical representations and responses to cardiac events between men and women suggest the need for carefully tailored interventions to each gender when attempting to educate the public on cardiac disease, with the aim of reducing delays in seeking treatment.