Gender differences in reasons patients delay in seeking treatment for acute myocardial infarction symptoms

https://doi.org/10.1016/j.pec.2003.11.011Get rights and content

Abstract

Patients (n=194) with confirmed acute myocardial infarction (AMI) were interviewed to determine sociodemographic, clinical, social, behavioral, cognitive and emotional factors that contribute to delay in seeking treatment for their symptoms. Initial symptom experience was similar for men and women: both were most commonly at home when symptoms began; both were most commonly in the presence of their spouse or other family member; few patients (<10%) called the emergency medical system as their first reaction. Several factors contributed similarly to delay in men and women. Factors that exerted a differential effect on delay between men and women were age, history of AMI, type of AMI (Q-wave and non-Q-wave), concerns about not wanting to trouble others, and prior knowledge of thrombolytics. There was no difference in delay between men and women (median 3.08 versus 3.10 h), but there are important gender differences in the reasons patients delay and in their patterns of decision-making that may assist clinicians trying to tailor interventions.

Section snippets

Background

Emergency medical response systems, emergency departments, and the health care providers who staff them have become more efficient at delivering timely reperfusion to patients presenting with symptoms of acute coronary syndrome. However, one major barrier remains to meeting the goal stated by National Heart Attack Alert Program of beginning reperfusion therapy within 1 h of symptom onset [1]. That barrier is patient delay in seeking treatment for symptoms, a major unresolved public health

Design, patients and setting

This study was a comparative survey examining gender differences in the reasons individuals delayed seeking treatment for the symptoms of AMI. Convenience sampling was used to select the sample. Patients were recruited from the cardiac care and cardiac step-down units of two sites, a community hospital and an academic medical center in the Midwest. Patients were referred to the project by charge nurses at both sites who first asked patients for their permission to allow a member of the research

Patient characteristics

A total of 194 patients, 96 women and 98 men, were enrolled in this study. The women who enrolled in this study were older, slightly less educated, had lower incomes, and were more often widowed than the men (Table 2). With regard to clinical characteristics, women expressed slightly higher levels of chest pain during AMI presentation, had higher admission pulse and lower admission diastolic blood pressure than men, while other clinical characteristics were similar (Table 2).

Delay times

Overall mean delay

Discussion

Previous findings about delay time between men and women have been conflicting. Some investigators [19], [20], [21] found that women delayed longer than men, while others [4], [5], [17], [18], documented no significant difference. The current study is unique because it is the first to enroll equal and sufficient numbers of both sexes to provide adequate power to test differences in delay times. The median delay time of 3.1 h documented in the present study is similar to those response times

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