Age and Sex Differences in Duration of Prehospital Delay in Patients With Acute Myocardial Infarction: A Systematic Review

Background—Coronary heart disease is the leading cause of morbidity and mortality in American men and women. Although there have been dramatic changes in the management of patients hospitalized with acute myocardial infarction (AMI) over the past several decades, a considerable proportion of patients with AMI continue to delay seeking medical care in a timely manner. This review provides an overview of the published literature that has examined age and sex differences in extent of prehospital delay in patients hospitalized with AMI. Methods and Results—A systematic review of the literature from 1960 to 2008, including publications that provided data on duration of prehospital delay in patients hospitalized with AMI, was conducted. A total of 44 articles (42 studies) were included in the present analysis. The majority of studies showed that in patients hospitalized with AMI, women and older persons were more likely to arrive at the hospital later than men and younger persons. Several factors associated with duration of prehospital delay, including sociodemographic, medical history, clinical, and contextual characteristics differed according to sex. Conclusions—The elderly and women were more likely to exhibit longer delays in seeking medical care after the development of symptoms suggestive of AMI compared with other groups. Further research is needed to more fully understand the reasons for delay in these vulnerable groups.

[1]  D. Moser,et al.  Treatment-seeking behavior for acute myocardial infarction symptoms in North America and Australia. , 2000, Heart & lung : the journal of critical care.

[2]  L. Køber,et al.  Determinants of delay between symptoms and hospital admission in 5978 patients with acute myocardial infarction. The TRACE Study Group. Trandolapril Cardiac Evaluation. , 1996, European heart journal.

[3]  B. Gersh,et al.  Time to Presentation With Acute Myocardial Infarction in the Elderly: Associations With Race, Sex, and Socioeconomic Characteristics , 2000, Circulation.

[4]  M. Eisenberg,et al.  Delay between onset of chest pain and seeking medical care: the effect of public education. , 1989, Annals of emergency medicine.

[5]  Y. Ohtsuki,et al.  ISOLATION OF HTLV-I FROM CEREBROSPINAL FLUID OF A PATIENT WITH MYELOPATHY , 1986, The Lancet.

[6]  T. Hole,et al.  Myocardial infarction: psychosocial aspects, gender differences and impact on pre-hospital delay. , 2008, Journal of advanced nursing.

[7]  D. Panagiotakos,et al.  Factors associated with delay in seeking health care for hospitalized patients with acute coronary syndromes: the GREECS study. , 2006, Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese.

[8]  Steven M. Paul,et al.  A Randomized Clinical Trial to Reduce Patient Prehospital Delay to Treatment in Acute Coronary Syndrome , 2009, Circulation. Cardiovascular quality and outcomes.

[9]  H. DeVon,et al.  Treatment Seeking for Acute Myocardial Infarction Symptoms: Differences in Delay Across Sex and Race , 2003, Nursing research.

[10]  E H Wagner,et al.  Absence of association between insurance copayments and delays in seeking emergency care among patients with myocardial infarction. , 1997, The New England journal of medicine.

[11]  R. M. Rubison,et al.  Factors influencing the time to administration of thrombolytic therapy with recombinant tissue plasminogen activator (data from the National Registry of Myocardial Infarction). Participants in the National Registry of Myocardial Infarction. , 1995, The American journal of cardiology.

[12]  R. Sabra,et al.  Gender differences in the diagnosis and treatment of acute myocardial infarction in Lebanon. , 1999, Le Journal medical libanais. The Lebanese medical journal.

[13]  J. Brophy,et al.  The delay to thrombolysis: an analysis of hospital and patient characteristics. Quebec Acute Coronary Care Working Group. , 1998, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[14]  E. Gjengedal,et al.  Are there gender differences related to symptoms of acute myocardial infarction? A Norwegian perspective. , 2006, Progress in cardiovascular nursing.

[15]  Sharon O'Donnell,et al.  In-hospital care pathway delays: gender and myocardial infarction. , 2005, Journal of advanced nursing.

[16]  M. P. Larsen,et al.  'Call fast, Call 911': a direct mail campaign to reduce patient delay in acute myocardial infarction. , 1997, American journal of public health.

[17]  F Van de Werf,et al.  Time from symptom onset to treatment and outcomes after thrombolytic therapy. GUSTO-1 Investigators. , 1996, Journal of the American College of Cardiology.

[18]  J. Brophy,et al.  The delay to thrombolysis: an analysis of patient and hospital characteristics , 1998 .

[19]  G. Taylor,et al.  Effect of a two-year public education campaign on reducing response time of patients with symptoms of acute myocardial infarction. , 1991, The American journal of cardiology.

[20]  J. Quinn,et al.  Delay in seeking care for symptoms of acute myocardial infarction: applying a theoretical model. , 2005, Research in nursing & health.

[21]  J. Salerno.  Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI). , 1986, Lancet.

[22]  V. Marder,et al.  Use of Thrombolytic Therapy for Acute Myocardial Infarction: Effects of Gender and Age on Treatment Rates , 2002, Journal of Thrombosis and Thrombolysis.

[23]  A. Rosenfeld,et al.  Treatment-Seeking Delay Among Women With Acute Myocardial Infarction: Decision Trajectories and Their Predictors , 2004, Nursing research.

[24]  S. Behar,et al.  Influence of gender in the therapeutic management of patients with acute myocardial infarction in Israel. The Israeli Thrombolytic Survey Group. , 1994, The American journal of cardiology.

[25]  D. Moser,et al.  Beyond sociodemographics: factors influencing the decision to seek treatment for symptoms of acute myocardial infarction. , 1997, Heart & lung : the journal of critical care.

[26]  A. Murphy,et al.  Factors influencing the decision to seek treatment for symptoms of acute myocardial infarction: an evaluation of the Self-Regulatory Model of illness behaviour. , 2004, Journal of psychosomatic research.

[27]  M. P. Larsen,et al.  Impact of Direct Mail Intervention on Knowledge, Attitudes, and Behavioral Intentions Regarding use of Emergency Medical Services for Symptoms of Acute Myocardial Infarction , 1994, Evaluation & the health professions.

[28]  H A Feldman,et al.  Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial. , 2000, JAMA.

[29]  S. Osganian,et al.  Prehospital delay in patients hospitalized with heart attack symptoms in the United States: the REACT trial. Rapid Early Action for Coronary Treatment (REACT) Study Group. , 1999, American heart journal.

[30]  M. P. Larsen,et al.  Prehospital delay interval for patients who use emergency medical services: the effect of heart-related medical conditions and demographic variables. , 1993, Annals of emergency medicine.

[31]  T. Hole,et al.  Prehospital Delay, Contributing Aspects and Responses to Symptoms among Norwegian Women and Men with First Time Acute Myocardial Infarction , 2007, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[32]  Sharon McKinley,et al.  Gender differences in reasons patients delay in seeking treatment for acute myocardial infarction symptoms. , 2005, Patient education and counseling.

[33]  K. Furie,et al.  Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2007, Circulation.

[34]  K. Dracup,et al.  Factors associated with prolonged prehospital delay of African Americans with acute myocardial infarction. , 2006, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[35]  B. Gersh,et al.  Factors associated with longer time from symptom onset to hospital presentation for patients with ST-elevation myocardial infarction. , 2008, Archives of internal medicine.

[36]  K. Puntillo,et al.  Gender differences in symptoms associated with acute myocardial infarction: a review of the research. , 2005, Heart & lung : the journal of critical care.

[37]  A. Timmis,et al.  How should age affect management of acute myocardial infarction? A prospective cohort study , 1999, The Lancet.

[38]  T. Heer,et al.  Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry). , 2002, The American journal of cardiology.

[39]  Gruppo Italiano per lo Studio della Soprawivenza nell'Inf Miocardico.,et al.  EFFECTIVENESS OF INTRAVENOUS THROMBOLYTIC TREATMENT IN ACUTE MYOCARDIAL INFARCTION , 1986, The Lancet.

[40]  J. Hampton,et al.  Early reporting of myocardial infarction: impact of an experiment in patient education. , 1982, British medical journal.

[41]  L. Ekström,et al.  Effect of a media campaign on delay times and ambulance use in suspected acute myocardial infarction. , 1989, The American journal of cardiology.

[42]  Sharon O'Donnell,et al.  Prehospital care pathway delays: gender and myocardial infarction. , 2006, Journal of advanced nursing.

[43]  B. Meyboom-de Jong,et al.  Longer pre-hospital delay in acute myocardial infarction in women because of longer doctor decision time. , 1999, Journal of epidemiology and community health.

[44]  C. Brulin,et al.  Time Trends in Symptoms and Prehospital Delay Time in Women vs. Men with Myocardial Infarction Over a 15-Year Period. The Northern Sweden MONICA Study , 2008, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[45]  M L Simoons,et al.  Psychological and knowledge factors related to delay of help-seeking by patients with acute myocardial infarction. , 1995, Psychotherapy and psychosomatics.

[46]  P. Thompson,et al.  Impact of a national educational campaign to reduce patient delay in possible heart attack. , 1993, Australian and New Zealand journal of medicine.

[47]  W. Weaver,et al.  Factors influencing the time to thrombolysis in acute myocardial infarction. Time to Thrombolysis Substudy of the National Registry of Myocardial Infarction-1. , 1997, Archives of internal medicine.

[48]  M. Haugh,et al.  Pre-hospital and hospital time delays in thrombolytic treatment in patients with suspected acute myocardial infarction. Analysis of data from the EMIP study. European Myocardial Infarction Project. , 1997, European heart journal.

[49]  J. Gore,et al.  Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction: the Worcester Heart Attack study. , 2000, Archives of internal medicine.

[50]  J. Herlitz,et al.  Prognosis in myocardial infarction in relation to gender. , 1994, American heart journal.

[51]  N. Black,et al.  The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. , 1998, Journal of epidemiology and community health.

[52]  L. Chambless,et al.  Trends in prehospital delay time and use of emergency medical services for acute myocardial infarction: experience in 4 US communities from 1987-2000. , 2005, American heart journal.

[53]  D. Morgan.  Effect of Incongruence of Acute Myocardial Infarction Symptoms on the Decision to Seek Treatment in a Rural Population , 2005, The Journal of cardiovascular nursing.

[54]  J. Gurwitz,et al.  Delayed Hospital Presentation in Patients Who Have Had Acute Myocardial Infarction , 1997, Annals of Internal Medicine.

[55]  M. P. Larsen,et al.  Gender differences in reported symptoms for acute myocardial infarction: impact on prehospital delay time interval. , 1998, The American journal of emergency medicine.

[56]  K. Furie,et al.  Heart disease and stroke statistics--2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2008, Circulation.

[57]  W. Mitic,et al.  The effect of a media campaign on heart attack delay and decision times. , 1984, Canadian journal of public health = Revue canadienne de sante publique.

[58]  J P Ornato,et al.  Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. , 2000, JAMA.

[59]  K. King,et al.  Symptom presentation and time to seek care in women and men with acute myocardial infarction. , 2007, Heart & lung : the journal of critical care.

[60]  J. Gurwitz,et al.  Duration of, and temporal trends (1994-1997) in, prehospital delay in patients with acute myocardial infarction: the second National Registry of Myocardial Infarction. , 1999, Archives of internal medicine.

[61]  G. Biondi-Zoccai,et al.  Letter by Agostini et al regarding article, "Stent thrombosis late after implantation of first-generation drug-eluting stents: a cause for concern". , 2007, Circulation.

[62]  Frans Van de Werf,et al.  An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. , 1993, The New England journal of medicine.

[63]  K. Dracup,et al.  Are there gender differences in the reasons why African Americans delay in seeking medical help for symptoms of an acute myocardial infarction? , 2007, Ethnicity & disease.

[64]  M. Al-Hassan,et al.  The effects of health beliefs on health care-seeking decisions of Jordanian patients with myocardial infarction symptoms. , 2005, International journal of nursing practice.

[65]  D. Stewart,et al.  Presentation, delay, and contraindication to thrombolytic treatment in females and males with myocardial infarction. , 2003, Women's health issues : official publication of the Jacobs Institute of Women's Health.

[66]  L. Goldman,et al.  Impact of a public campaign on pre-hospital delay in patients reporting chest pain. , 1996, Heart.

[67]  A. Ruhparwar.  Spotlight: Arjang Ruhparwar, MD. Interview by Richard Hoey. , 2008, Circulation.

[68]  A. Tonkin,et al.  Failure of current public educational campaigns to impact on the initial response of patients with possible heart attack , 2005, Internal medicine journal.

[69]  David Brieger,et al.  Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry). , 2002, The American journal of cardiology.

[70]  Niccolò Marchionni,et al.  In-hospital management and outcome in women with acute myocardial infarction (data from the AMI-Florence Registry). , 2004, The American journal of cardiology.

[71]  J. Gurwitz,et al.  Trends in prehospital delay in patients with acute myocardial infarction (from the Worcester Heart Attack Study). , 2008, The American journal of cardiology.

[72]  R. Califf,et al.  Persistence of delays in presentation and treatment for patients with acute myocardial infarction: The GUSTO-I and GUSTO-III experience. , 2002, Annals of emergency medicine.