Neighborhood Income, Health Insurance, and Prehospital Delay for Myocardial Infarction

Part 10: Acute Coronary Syndromes

“…Patient-based delay in recognition of ACS and activation of the emergency medical services (EMS) system often constitutes the longest period of delay to treatment. 5 With respect to the prehospital recognition of ACS, numerous issues have been identified as independent factors for prehospital treatment delay (ie, symptom-to-door time), including older age, 6 racial and ethnic minorities, 7,8 female gender, 9 lower socioeconomic status, 10,11 and solitary living arrangements. 7,12 Hospital-based delays in ACS recognition range from nonclassical patient presentations and other confounding diagnostic issues to provider misinterpretation of patient data and inefficient in-hospital system of care.…”

Gender and Age Differences Associated With Prehospital Delay in Chinese Patients Presenting With ST-Elevation Myocardial Infarction

“…These results are indicators of low socioeconomic status and reduced social support, which likely contributes to a slower reaction to symptoms and delayed prehospital presentation. 22,23 The previous study involving the Beijing area in China reported that education level at senior high school and above significantly influenced prehospital delay. 15 Patients with STEMI who interpreted their symptoms as cardiac in origin were more likely to have a higher education level than those who did not interpret their symptoms as cardiac in origin.…”

Socioeconomic status and incidence of sudden cardiac arrest

“…Individuals of lower socioeconomic status have been found to have a greater burden of risk factors for cardiovascular disease, 13 poorer control of established cardiovascular risk factors 14 and longer delays in seeking hospital care for acute myocardial infarction. 15 Numerous studies have also shown that disparities in health outcomes are apparent across the spectrum of socioeconomic status. 16 A better understanding of community-level patterns in the distribution of sudden cardiac arrest may identify opportunities for improving survival, such as effective targeting of community training for cardiopulmonary resuscitation and placement of automated external defibrillators in lower-income communities.…”

“…14 Patients of lower socioeconomic status in the United States have also been shown to delay seeking hospital care for acute myocardial infarction. 15 A substantial proportion of patients who have sudden cardiac arrest have symptoms such as angina, dyspnea, nausea and syncope for minutes to hours before the arrest. 27 A delay in calling for emergency medical services could result in a higher incidence of sudden cardiac arrest in the poorer, uninsured population.…”