Age and Sex Differences in Duration of Prehospital Delay in Patients With Acute Myocardial Infarction

Abstract

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. (Circ Cardiovasc Qual Outcomes. 2010;3:82-92.)

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

“…In addition, international guidelines recommend that reperfusion therapy should be performed within 90 min after the onset of symptoms [23]. A recent systematic review has shown the reliability of reporting pre-hospital delay and the effect of patient features on it [24]. On the other hand, studies comparing yearly trends of reported pre-hospital delay have interestingly remarked that average delay times have remained essentially unchanged during the past two decades [25].…”

Decade Long Trends (2001–2011) in Duration of Pre‐Hospital Delay Among Elderly Patients Hospitalized for an Acute Myocardial Infarction

“…Although the majority of studies that have examined extent of prehospital delay among patients presenting with AMI in the United States have found median delays of ≈2 to 3 hours7, 8, 17, 20, 21, 22, 23 with most of these studies showing higher delay times in elderly than in younger patients,8, 24 few studies have examined the magnitude of, and factors associated with, prolonged delay in seeking medical care after onset of acute coronary symptoms in elderly patients presenting with AMI 9. Furthermore, we were unable to find any published studies that examined the extent of prehospital delay within different age strata of elderly patients hospitalized with an AMI.…”

“…Furthermore, we were unable to find any published studies that examined the extent of prehospital delay within different age strata of elderly patients hospitalized with an AMI. Many studies have, however, included varying proportions of elderly patients in their study population and observed median prehospital delays ranging from 2.2 to 2.8 hours in these patients 7, 8, 9, 25…”

“…Furthermore, relatively diminished chest pain sensation in the elderly, relatively high frequency of cognitive impairment, presence of multiple cardiovascular and noncardiovascular comorbidities, and social situations of the elderly further challenge their ability to seek care earlier 8, 24…”

“…Although several studies have examined trends in, and factors associated with, duration of prehospital delay in all patients who present with an AMI, few studies have examined the extent of, and relatively recent trends in, prehospital delay in seeking acute medical care among the high‐risk subgroup of elderly persons who are hospitalized with an AMI 7, 8, 9. In addition, few studies have examined the characteristics associated with prolonged delay in elderly patients experiencing an AMI and whether these factors differ among those in various age strata among persons 65 years and older.…”