Prehospital care pathway delays: gender and myocardial infarction

This paper reports the findings of a study that identified gender specific prehospital care pathway delays amongst Irish women and men with myocardial infarction. Women are more likely to experience a poorer prognosis than their male counterparts following hospitalization for myocardial infarction, yet research shows that women continue to experience prehospital care pathway delays. A 1-year prospective census was carried in six major academic teaching hospitals in Dublin, Ireland in 2001-2002. A total of 277 (31%) female and 613 (69%) male patients with confirmed myocardial infarction were included in the study. Women were more likely to experience prolonged 'initial symptom-onset to A&E delays' (14 hours vs. 2.8 hours P < 0.0001), and 'intense symptom-onset to A&E delays' (3.1 hours vs. 1.8 hours , P < 0.0001), i.e. arrival at a hospital accident and emergency department. Advancing age was associated with greater prehospital delays (P < 0.0001), whilst patients with private health insurance had shorter delays than public patients (without private health insurance) or those with medical cards (entitling them to means-tested medical benefits) (P = 0.001). Patients who drove themselves by car to hospital had shorter median prehospital times than those arriving by any other admission mode (P < 0.0001), whilst those referred by their general practitioner had longer delays than those who were self-referred (5 hours vs. 1.7 hours, P < 0.0001). Female gender, advancing age, referral source, insurance status and mode of transport to hospital are independent factors contributing to prehospital patient delays. Nurses who care for patients with coronary artery disease have a unique opportunity to educate people about the most appropriate action to be taken in the event of experiencing symptoms.