Circulation: Female MI patients still experiencing delays in care

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Compared with otherwise similar men, women have 50 percent greater odds of being delayed in the emergency medical services (EMS) setting, and the determinants of delay should be a special focus of EMS studies in which time-to-treatment is a priority, according to a study published online Jan. 13 in Circulation: Cardiovascular Quality and Outcomes.

Thomas W. Concannon, PhD, an assistant professor of medicine at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center in Boston, and colleagues set out to identify patient-level and neighborhood-level factors that were associated with elapsed time in EMS.

They conducted this retrospective cohort study across 10 municipalities in Dallas County in 29 hospitals and 98 EMS depots, from Jan. 1, 2004 through Dec. 31, 2004. The data set included 5,887 patients with suspected cardiac-related symptoms. People with the symptoms were equally divided between men and women; half were white.

“Our data didn't reveal why women were delayed or what happened after, [but] other research suggests that heart conditions in women have a broader spectrum [of symptoms] than men,” Concannon said. “The patient could not be recognizing the symptoms, and also the clinician.”

The researchers said that the main outcomes were elapsed time in EMS (continuous; in minutes) and delay in EMS (more than15 minutes beyond median elapsed time). They found positive associations between patient characteristics and both average elapsed time and delay in EMS care.  

However, approximately 11 percent of patients were delayed 15 minutes or more, according to the authors.
The investigators found that women were more likely to be delayed, and the association did not change after adjusting for other characteristics, including neighborhood socioeconomic composition. On average, women took 2.3 minutes longer to get to the hospital than men, not considered a critical difference.

Concannon said that "future research is absolutely needed to explore delays of this nature, and why they're happening.”