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Gender disparities in first medical contact and delay in ST-elevation myocardial infarction: a prospective multicentre Swedish survey study
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Department of Medicine, Stanford Prevention Research Center, CA, United States.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Department of Research, Norrbotten County Council, Luleå, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Department of Nursing, Umeå University, Umeå, Sweden; Cardiology, Heart Centre, Umeå University, Umeå, Sweden.
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 5, article id e020211Article in journal (Refereed) Published
Abstract [en]

Objectives Compare gender disparities in ST-elevation myocardial infarction (STEMI) regarding first medical contact (FMC) and prehospital delay times and explore factors associated with prehospital delay in men and women separately. Design Cross-sectional study based on medical records and a validated questionnaire. Eligible patients were enrolled within 24 hours after admittance to hospital. Setting Patients were included from November 2012 to January 2014 from five Swedish hospitals with catheterisation facilities 24/7. Participants 340 men and 109 women aged between 31 and 95 years completed the survey. Main outcome measures FMC were divided into five possible contacts: primary healthcare centre by phone or directly, national advisory nurse by phone, emergency medical services (EMS) and emergency room directly. Two parts of prehospital delay times were studied: time from symptom onset to FMC and time from symptom onset to diagnostic ECG. Results Women more often called an advisory nurse as FMC (28% vs 18%, p=0.02). They had a longer delay until FMC, 90 (IOR 39-221) vs 66 (28-161) min, p=0.04 and until ECG, 146 (68-316) vs 103 (61-221) min, p=0.03. Men went to hospital because of believing they were stricken by an MI to a higher extent than women did (25% vs 15%, p=0.04) and were more often recommended to call EMS by bystanders (38% vs 22%, pamp;lt;0.01). Hesitating about going to hospital and experiencing pain in the stomach/back/shoulders were factors associated with longer delays in women. Believing the symptoms would disappear or interpreting them as nothing serious were corresponding factors in men. In both genders bystanders acting by contacting EMS explained shorter prehospital delays. Conclusions In STEMI, women differed from men in FMC and they had longer delays. This was partly due to atypical symptoms and a longer decision time. Bystanders acted more promptly when men than when women fell ill. Public knowledge of MI symptoms, and how to act properly, still seems insufficient.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018. Vol. 8, no 5, article id e020211
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General Practice
Identifiers
URN: urn:nbn:se:liu:diva-149740DOI: 10.1136/bmjopen-2017-020211ISI: 000435567200080PubMedID: 29724738OAI: oai:DiVA.org:liu-149740DiVA, id: diva2:1233567
Note

Funding Agencies|Medical Research Council of Southeast Sweden (FORSS); County Council of Ostergotland; County Council of Norrbotten

Available from: 2018-07-18 Created: 2018-07-18 Last updated: 2018-08-10Bibliographically approved

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Sederholm Lawesson, SofiaIsaksson, Rose-MarieEricsson, MariaThylén, Ingela
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Department of Medical and Health SciencesFaculty of Medicine and Health SciencesDepartment of Cardiology in LinköpingDivision of Nursing ScienceDivision of Cardiovascular Medicine
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