Acute Coronary Syndrome: Factors Affecting Time to Arrival in a Diverse Urban Setting

Abstract

This study seeks to better understand how individuals of different cultural/ethnic backgrounds in an urban setting assess the signs and symptoms of Acute Coronary Syndrome (ACS) and the ensuing decision to take urgent action. Few studies exist which examine these differences and enhance understanding of how to address these differences and, ultimately, reduce morbidity and mortality from ACS. Face-to-face interviews were conducted with a convenience sample of urban patients of different cultural and socioeconomic backgrounds regarding their actions upon recognition of ACS signs and symptoms. Patients (423) with presumed or diagnosed ACS were interviewed within 12 h of arrival at the urban emergency rooms. Among the different cultural groups, Haitians delayed the longest (median) from symptom onset to hospital arrival (8.24 h), followed by Caribbeans (7.83 h), African Americans (6.62 h) and Hispanics (6.00 h). Although these delay intervals were not statistically significant across groups, each racial/ethnic group sought care well beyond the recommended time period of 3 h after initial recognition of ACS signs and symptoms. Among all the cultural groups, the two key factors motivating early arrival were being employed and taking positive actions. ACS symptom perception by different cultural groups appears to play an important role in the decision to seek emergency treatment. This is an area that has not been widely studied among or within different cultural/ethnic groups. As such, further research is needed to delineate these concepts and actions and to provide opportunities for appropriate education.

Disparities in patients presenting to the emergency department with potential acute coronary syndrome: It matters if you are Black or White

“…Our findings were also similar to Deshmukh et al 16 who examined a sample of four ethnic minority groups in New York and found that Haitians, Caribbeans, African Americans and Hispanics all delayed significantly longer than the recommended 3 hours for reperfusion therapy. However, after adjusting for multiple factors known to increase prehospital delay, including race, age, sex, diabetes, diagnosis, number of symptoms, symptom distress, and abrupt vs. gradual symptom onset, race was not a significant predictor in our study.…”

“…6 Despite well-known reductions in morbidity and mortality when patients receive treatment within three hours of symptom onset, 13,16,17 Blacks experiencing ACS symptoms have longer pre-hospital delay times compared to Whites. 18-20 Additional prehospital delay by Blacks may be a result of limited healthcare access, variations in symptoms, lack of understanding of the significance of symptoms, 6 or socioeconomic status (SES).…”

Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions

“…There have been numerous studies investigating presentation, diagnosis, and management of acute coronary syndrome (ACS) and the influence of race [1, 9••, 46–48]. Despite the attention, recent studies continue to demonstrate disparities in management and outcomes.…”

Chest pain in general practice: Frequency, management, and results of encounter

“…Furthermore, there is an influence on how individual patients of different cultural backgrounds respond to chest pain, for example to symptoms of the acute coronary syndrome. [ 19 ] These assumptions are supported by the fact that the Swiss Thoracic Pain in Community (TOPIC) study, which was performed in a time period and with a population comparable to those in the German SESAM 2 study, revealed a nearly equal consultation frequency of chest pain [ Table 4 ]. However, the higher rate in the German SESAM 2 study is unlikely to be influenced by attention bias since the study estimated total morbidity.…”