Factors Associated With Longer Time to Treatment for Patients With Suspected Acute Coronary Syndromes

Abstract

Background Rapid treatment of acute coronary syndromes (ACS) is important; causes of delay in emergency medical services (EMS) care of ACS are poorly understood. Methods and results Analysis of data from the IMMEDIATE randomized controlled trial of EMS treatment of people with symptoms suggesting ACS, using hierarchical multiple regression of elapsed time. Out-of-hospital electrocardiograms were performed on 54,230 adults calling 9-1-1; 871 had presumed ACS, 303 of whom had ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention. Compared to their counterparts, women, participants with diabetes, and participants without prior cardiovascular disease waited longer to call 9-1-1(by 28, p <0.01; 10, p 0.03; and 6 minutes, p 0.02, respectively). EMS arrival to electrocardiogram was longer for women (1.5 minutes, p <0.01), older individuals (1.3 minutes, p <0.01), and those without a primary complaint of chest pain (3.5 minutes, p <0.01). On-scene times were longer for women (2 minutes, p < 0.01) and older individuals (2 minutes, p <0.01). Older individuals and participants presenting on weekends and nights had longer door-to-balloon times (by 10, 14 and 11 minutes respectively, p < 0.01). Women and older individuals had longer total times (medical contact to balloon inflation 16, p 0.01, and 9 minutes, p <0.01, respectively; symptom onset to balloon inflation 31.5 minutes for women, p 0.02). Conclusions We found delays throughout ACS care, resulting in substantial differences in total times for women and older individuals. These delays may impact outcomes; a comprehensive approach to reduce delay is needed.

Delays in Seeking Care

“…4 Finally, patients may not be the only ones delaying care for women compared with men: one recent study showed that among young patients with MI, women were significantly more likely to experience a delay to reperfusion, 20 and other studies have found similar evidence of associations between sex and reperfusion delay as well. 21,22 Additionally, longer symptom-to-presentation time is independently associated with longer presentation-to-reperfusion time, suggesting that delays may beget delays in treatment for MI.…”

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

“…Furthermore, female patients tend to have longer D2B times than their male counterparts 12. In 2006, the ACC launched the D2B Alliance, which focused on standardized systematic approaches to STEMI patients and ultimately reduced D2B times and created more parity in reperfusion times related to sex 6, 13, 14, 15. The effects of prehospital care and subsequent D2B time, which are captured by C2D times, have not been previously analyzed to explore the association with mortality and potential sex‐linked disparities.…”

Tempos de acesso a serviços de saúde face ao infarto do miocárdio

“…(19) It is known that cognitive and emotional factors (interpretations, thoughts and actions in view of infarction symptoms) are associated with the delayed decision to seek care. (20) Educational activities by nurses should focus on these factors in order to optimize the search for care.…”