Gender disparities in first medical contact and delay in ST-elevation myocardial infarction: a prospective multicentre Swedish survey study

Abstract

ObjectivesCompare gender disparities in ST-elevation myocardial infarction (STEMI) regarding first medical contact (FMC) and prehospital delay times and explore factors associated with prehospital delay in men and women separately.DesignCross-sectional study based on medical records and a validated questionnaire. Eligible patients were enrolled within 24 hours after admittance to hospital.SettingPatients were included from November 2012 to January 2014 from five Swedish hospitals with catheterisation facilities 24/7.Participants340 men and 109 women aged between 31 and 95 years completed the survey.Main outcome measuresFMC were divided into five possible contacts: primary healthcare centre by phone or directly, national advisory nurse by phone, emergency medical services (EMS) and emergency room directly. Two parts of prehospital delay times were studied: time from symptom onset to FMC and time from symptom onset to diagnostic ECG.ResultsWomen more often called an advisory nurse as FMC (28% vs 18%, p=0.02). They had a longer delay until FMC, 90 (IQR 39–221) vs 66 (28–161) min, p=0.04 and until ECG, 146 (68–316) vs 103 (61–221) min, p=0.03. Men went to hospital because of believing they were stricken by an MI to a higher extent than women did (25% vs 15%, p=0.04) and were more often recommended to call EMS by bystanders (38% vs 22%, p<0.01). Hesitating about going to hospital and experiencing pain in the stomach/back/shoulders were factors associated with longer delays in women. Believing the symptoms would disappear or interpreting them as nothing serious were corresponding factors in men. In both genders bystanders acting by contacting EMS explained shorter prehospital delays.ConclusionsIn STEMI, women differed from men in FMC and they had longer delays. This was partly due to atypical symptoms and a longer decision time. Bystanders acted more promptly when men than when women fell ill. Public knowledge of MI symptoms, and how to act properly, still seems insufficient.

Prehospital and in-hospital delays to care and associated factors in patients with STEMI: an observational study in 101 non-PCI hospitals in China

“…Our findings that women were more likely to have prehospital delays among patients with STEMI have been reported in previous studies 9 11 20 28 29. Possible explanations include women suffering more atypical symptoms,30 31 the women-discriminating culture and lower socioeconomic status,32 more sympathy that prevents women from troubling anyone33 and so on.…”

Pain in emergency units: correlation with risk classification categories

“…In this study, women predominated in the demand for Emergency Service in relation to men Some factors that may explain this is the resistance of men to seek health care due to societal taboos and gender-related sociocultural factors in which diseases are considered a sign of fragility and the search for medical services, a demonstration of weakness 11 .…”

Pre-hospital delay and emergency medical services in acute myocardial infarction

“…Previous studies have focused on identifying the clinical, socioeconomic, or regional factors that cause a delayed STDT among STEMI patients [15,[20][21][22][23][24][25][26][27][28]. Those risk factors were female gender [20][21][22][23][24][25], older age [21][22][23]26], diabetes [21][22][23][24], and atypical symptoms [22,[25][26][27]. Other predictors might be night time presentation [15,23], longer decision time [20,25], and non-utilisation EMS [15,22,28,29].…”

“…Those risk factors were female gender [20][21][22][23][24][25], older age [21][22][23]26], diabetes [21][22][23][24], and atypical symptoms [22,[25][26][27]. Other predictors might be night time presentation [15,23], longer decision time [20,25], and non-utilisation EMS [15,22,28,29]. Although public campaigns and educational programs targeting those factors have been implemented, there is little evidence that they have successfully reduced treatment delays [30].…”

“…We confirmed that old age, female gender, and renewed ischemia were independent factors predictive of delayed STDT. Both older age and female gender have previously been associated with atypical symptoms, and have been shown to strongly affect STDT [25,26]; hence, we included the interaction terms in the multivariate analyses. Because patients who presented with cardiogenic shock were likely to visit the hospital earlier, an additional subgroup analysis for cardiogenic shock was performed.…”