Ethnicity-based Differences in Treatment-seeking for Symptoms of Acute Coronary Syndrome

Abstract

Background: Patient-related delays in acquiring medical care for symptoms of acute coronary syndrome (ACS) remain unacceptably long despite campaigns aimed at raising awareness of the importance of timely presentation to an urgent care facility. Patients who delay seeking treatment for ACS often experience delays in treatment initiation, which can lead to poorer outcomes. Many sociodemographic characteristics associated with treatment-seeking delay are known, however ethnicity and how it relates to delay, have not been extensively evaluated. Objective: The purpose of this study was to explore ethnicity-based factors to determine how they relate to the treatment-seeking decisions of patients experiencing symptoms of ACS. Method: Data for this descriptive study were collected for the Acute Coronary Syndrome Care in Emergency Departments ("ASCEND") study. The ASCEND study is a prospective, observational study in which patients presenting to hospital emergency departments and triaged as having symptoms suggestive of ACS are identified. The primary outcome of this study, the patients' time-to-treatment interval, was defined as the time between the occurrences of symptom onset and appropriate treatment seeking. The predictor variable, ethnicity, was measured with the self-reported data and categorized as Chinese, South Asian, or "Other" ethnic groups. Univariate and multivariate analyses were used along with nonparametric testing. Results: The study sample consisted of 401 participants; 30 Chinese, 102 South Asian, and 269 participants who were characterized as "Other". The median time-to-treatment-seeking interval, for the total sample, was 180 minutes (IQR = 1,170 minutes). A Kruskal-Wallis test iii demonstrated no statistically significant differences in the time-to-treatment intervals by ethnicity; however, the sample may not have provided sufficient statistical power to detect a difference. No ethnic differences were found in the participants' reasons for employing the coping strategies or actions that led to their treatment-seeking delay. A statistically significant relationship was found between ethnicity and the actions taken by the participants in response to their symptoms of ACS. The South Asian participants were most likely to call for the help of a family member, co-worker or stranger nearby, or telephoned a family member, which likely prolonged the time it took to obtain medical care. iv Preface This thesis is based on data from the Acute Coronary Syndrome Care in Emergency Departments ("ASCEND") study, a prospective, observational study (Dr. Martha Mackay is the principal investigator). None of the text of the thesis is taken from previously published manuscripts. The study was approved by the University of British Columbia, Providence Health Care Research Ethics Boards (REB) (certificate UBC-PHC #H13-00617).