Yonsei Med J.  2017 Jul;58(4):710-719. 10.3349/ymj.2017.58.4.710.

Gender Differences in Factors Related to Prehospital Delay in Patients with ST-Segment Elevation Myocardial Infarction

Affiliations
  • 1Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Korea.
  • 2Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Korea.
  • 3Department of Preventive Medicine, Konkuk University College of Medicine, Seoul, Korea.
  • 4Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
  • 5Department of Internal Medicine, Chungnam National University Hospital and School of Medicine, Daejeon, Korea.
  • 6Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
  • 7Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
  • 8Department of Cardiovascular Medicine, Wonkwang University Hospital, Iksan, Korea.
  • 9Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
  • 10Department of Internal Medicine, Gyeongsang National University School of Medicine and Hospital, Jinju, Korea.
  • 11Department of Preventive Medicine, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea. parkks@gnu.ac.kr
  • 12Center for Regional Cardiocerebrovascular Disease, Gyeongsang National University Hospital, Jinju, Korea. krb747@gmail.com

Abstract

PURPOSE
The aim of our study was to investigate gender differences in factors related to prehospital delay and identify whether the knowledge of acute myocardial infarction symptoms affects this delay in Korean patients with ST-elevation myocardial infarction (STEMI).
MATERIALS AND METHODS
A total of 350 patients (286 men, 64 women) with confirmed STEMI were interviewed to investigate socio-demographics, history of disease, symptom onset time, and factors that contributed to delayed decision time in seeking treatment and hospital arrival time from symptom onset. Factors associated with prehospital delay were examined separately by gender using univariate and multivariate analyses.
RESULTS
Female patients had higher proportions of ≥60-minute decision time and ≥120-minute arrival time compared to male patients (33.9% vs. 23.1%, 60.9% vs. 52.1%, respectively). However, the difference was not statistically significant (p=0.093 and 0.214, respectively). Previous cardiovascular disease (CVD) was associated with increased decision time in men, whereas, in women, lower educational status caused a greater delay in decision time. Factors associated with hospital arrival time excluding delayed decision time were referral from another hospital, previous CVD, and percutaneous coronary intervention in men, and referral from another hospital in women.
CONCLUSION
Gender differences exist in factors related to prehospital delay. Therefore, public education to reduce prehospital delay should be conducted according to gender with a focus on the pertinent factors.

Keyword

Acute coronary syndrome; healthcare timeout; sex differences

MeSH Terms

Aged
Demography
Emergency Service, Hospital
Female
*Hospitalization
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Percutaneous Coronary Intervention
ST Elevation Myocardial Infarction/*diagnostic imaging
*Sex Characteristics
Time Factors

Figure

  • Fig. 1 Proportion for patients of the ≥60 minutes of symptoms to decision seek help time and the ≥120 minutes of symptoms to emergency room arrival time between male and female. Error bars on the bar chart is standard error.


Reference

1. Bulluck H, Yellon DM, Hausenloy DJ. Reducing myocardial infarct size: challenges and future opportunities. Heart. 2016; 102:341–348.
Article
2. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). J Am Coll Cardiol. 2004; 44:E1–E211.
3. Baek YS, Park SD, Kim SH, Lee MJ, Shin SH, Kim DH, et al. Clinical and angiographic predictors of microvascular dysfunction in ST-segment elevation myocardial infarction. Yonsei Med J. 2015; 56:1235–1243.
Article
4. Nguyen HL, Saczynski JS, Gore JM, Goldberg RJ. Age and sex differences in duration of prehospital delay in patients with acute myocardial infarction: a systematic review. Circ Cardiovasc Qual Outcomes. 2010; 3:82–92.
Article
5. Goldberg RJ, Spencer FA, Fox KA, Brieger D, Steg PG, Gurfinkel E, et al. Prehospital delay in patients with acute coronary syndromes (from the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol. 2009; 103:598–603.
Article
6. Peng YG, Feng JJ, Guo LF, Li N, Liu WH, Li GJ, et al. Factors associated with prehospital delay in patients with ST-segment elevation acute myocardial infarction in China. Am J Emerg Med. 2014; 32:349–355.
Article
7. Løvlien M, Schei B, Hole T. Prehospital delay, contributing aspects and responses to symptoms among Norwegian women and men with first time acute myocardial infarction. Eur J Cardiovasc Nurs. 2007; 6:308–313.
Article
8. Isaksson RM, Holmgren L, Lundblad D, Brulin C, Eliasson M. The Northern Sweden MONICA Study. Time trends in symptoms and prehospital delay time in women vs. men with myocardial infarction over a 15-year period. Eur J Cardiovasc Nurs. 2008; 7:152–158.
Article
9. Fukuoka Y, Dracup K, Rankin SH, Froelicher ES, Kobayashi F, Hirayama H, et al. Prehospital delay and independent/interdependent construal of self among Japanese patients with acute myocardial infarction. Soc Sci Med. 2005; 60:2025–2034.
Article
10. Park YH, Kang GH, Song BG, Chun WJ, Lee JH, Hwang SY, et al. Factors related to prehospital time delay in acute ST-segment elevation myocardial infarction. J Korean Med Sci. 2012; 27:864–869.
Article
11. Hwang SY, Zerwic JJ, Jeong MH. Impact of prodromal symptoms on prehospital delay in patients with first-time acute myocardial infarction in Korea. J Cardiovasc Nurs. 2011; 26:194–201.
Article
12. Goldberg RJ, Steg PG, Sadiq I, Granger CB, Jackson EA, Budaj A, et al. Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry). Am J Cardiol. 2002; 89:791–796.
Article
13. Dracup K, Moser DK, Eisenberg M, Meischke H, Alonzo AA, Braslow A. Causes of delay in seeking treatment for heart attack symptoms. Soc Sci Med. 1995; 40:379–392.
Article
14. Moser DK, Kimble LP, Alberts MJ, Alonzo A, Croft JB, Dracup K, et al. Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council. Circulation. 2006; 114:168–182.
Article
15. DeVon HA, Ryan CJ, Rankin SH, Cooper BA. Classifying subgroups of patients with symptoms of acute coronary syndromes: a cluster analysis. Res Nurs Health. 2010; 33:386–397.
Article
16. Meischke H, Larsen MP, Eisenberg MS. Gender differences in reported symptoms for acute myocardial infarction: impact on prehospital delay time interval. Am J Emerg Med. 1998; 16:363–366.
Article
17. Moser DK, McKinley S, Dracup K, Chung ML. Gender differences in reasons patients delay in seeking treatment for acute myocardial infarction symptoms. Patient Educ Couns. 2005; 56:45–54.
Article
18. Goff DC Jr, Feldman HA, McGovern PG, Goldberg RJ, Simons-Morton DG, Cornell CE, et al. Rapid Early Action for Coronary Treatment (REACT) Study Group. Prehospital delay in patients hospitalized with heart attack symptoms in the United States: the REACT trial. Am Heart J. 1999; 138(6 Pt 1):1046–1057.
Article
19. Goldberg RJ, Yarzebski J, Lessard D, Gore JM. Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction: the Worcester Heart Attack study. Arch Intern Med. 2000; 160:3217–3223.
Article
20. Jneid H, Fonarow GC, Cannon CP, Hernandez AF, Palacios IF, Maree AO, et al. Sex differences in medical care and early death after acute myocardial infarction. Circulation. 2008; 118:2803–2810.
Article
21. American College of Emergency Physicians. Society for Cardiovascular Angiography and Interventions. O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013; 61:485–510.
22. Rosengren A, Wallentin L, K Gitt A, Behar S, Battler A, Hasdai D. Sex, age, and clinical presentation of acute coronary syndromes. Eur Heart J. 2004; 25:663–670.
Article
23. Canto JG, Goldberg RJ, Hand MM, Bonow RO, Sopko G, Pepine CJ, et al. Symptom presentation of women with acute coronary syndromes: myth vs reality. Arch Intern Med. 2007; 167:2405–2413.
Article
24. Hailer B, Naber C, Koslowski B, van Leeuwen P, Schäfer H, Budde T, et al. Gender-related differences in patients with ST-elevation myocardial infarction: results from the registry study of the ST elevation myocardial infarction network Essen. Clin Cardiol. 2011; 34:294–301.
Article
25. Canto JG, Rogers WJ, Goldberg RJ, Peterson ED, Wenger NK, Vaccarino V, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012; 307:813–822.
Article
26. Walsh JC, Lynch M, Murphy AW, Daly K. Factors influencing the decision to seek treatment for symptoms of acute myocardial infarction: an evaluation of the Self-Regulatory Model of illness behaviour. J Psychosom Res. 2004; 56:67–73.
Article
27. McGinn AP, Rosamond WD, Goff DC Jr, Taylor HA, Miles JS, Chambless L. Trends in prehospital delay time and use of emergency medical services for acute myocardial infarction: experience in 4 US communities from 1987-2000. Am Heart J. 2005; 150:392–400.
Article
28. Ting HH, Bradley EH, Wang Y, Lichtman JH, Nallamothu BK, Sullivan MD, et al. Factors associated with longer time from symptom onset to hospital presentation for patients with ST-elevation myocardial infarction. Arch Intern Med. 2008; 168:959–968.
Article
29. McKee G, Mooney M, O'Donnell S, O'Brien F, Biddle MJ, Moser DK. Multivariate analysis of predictors of pre-hospital delay in acute coronary syndrome. Int J Cardiol. 2013; 168:2706–2713.
Article
30. Heer T, Gitt AK, Juenger C, Schiele R, Wienbergen H, Towae F, et al. Gender differences in acute non-ST-segment elevation myocardial infarction. Am J Cardiol. 2006; 98:160–166.
Article
31. Løvlien M, Schei B, Hole T. Myocardial infarction: psychosocial aspects, gender differences and impact on pre-hospital delay. J Adv Nurs. 2008; 63:148–154.
Article
32. Grace SL, Abbey SE, Bisaillon S, Shnek ZM, Irvine J, Stewart DE. Presentation, delay, and contraindication to thrombolytic treatment in females and males with myocardial infarction. Womens Health Issues. 2003; 13:214–221.
Article
33. Dracup K, Moser DK. Beyond sociodemographics: factors influencing the decision to seek treatment for symptoms of acute myocardial infarction. Heart Lung. 1997; 26:253–262.
Article
34. McKinley S, Moser DK, Dracup K. Treatment-seeking behavior for acute myocardial infarction symptoms in North America and Australia. Heart Lung. 2000; 29:237–247.
Article
35. Heer T, Schiele R, Schneider S, Gitt AK, Wienbergen H, Gottwik M, et al. Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry). Am J Cardiol. 2002; 89:511–517.
Article
36. O'Donnell S, Condell S, Begley C, Fitzgerald T. Prehospital care pathway delays: gender and myocardial infarction. J Adv Nurs. 2006; 53:268–276.
37. Mooney M, McKee G, Fealy G, O'Brien F, O'Donnell S, Moser D. A randomized controlled trial to reduce prehospital delay time in patients with acute coronary syndrome (ACS). J Emerg Med. 2014; 46:495–506.
Article
38. Kirchberger I, Heier M, Golüke H, Kuch B, von Scheidt W, Peters A, et al. Mismatch of presenting symptoms at first and recurrent acute myocardial infarction. From the MONICA/KORA Myocardial Infarction Registry. Eur J Prev Cardiol. 2016; 23:377–384.
Article
39. Zhang B, Zhang W, Huang R, Zhu H, Liu J, Jiang D, et al. Gender and age differences associated with prehospital delay in Chinese patients presenting with ST-elevation myocardial infarction. J Cardiovasc Nurs. 2016; 31:142–150.
Article
40. Song L, Yan HB, Yang JG, Sun YH, Hu DY. Impact of patients' symptom interpretation on care-seeking behaviors of patients with acute myocardial infarction. Chin Med J (Engl). 2010; 123:1840–1845.
41. Nguyen HL, Gore JM, Saczynski JS, Yarzebski J, Reed G, Spencer FA, et al. Age and sex differences and 20-year trends (1986 to 2005) in prehospital delay in patients hospitalized with acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2010; 3:590–598.
Article
42. Johansson I, Strömberg A, Swahn E. Factors related to delay times in patients with suspected acute myocardial infarction. Heart Lung. 2004; 33:291–300.
Article
43. Perkins-Porras L, Whitehead DL, Strike PC, Steptoe A. Pre-hospital delay in patients with acute coronary syndrome: factors associated with patient decision time and home-to-hospital delay. Eur J Cardiovasc Nurs. 2009; 8:26–33.
Article
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