Cardiology fellow University of Manitoba Winnipeg, Manitoba, Canada
Background: Timely access to percutaneous coronary intervention (PCI) remains the standard of care for acute coronary syndrome (ACS). Despite improvements in door-to-balloon times, delays from symptom onset (SO) to first medical contact (FMC) persist. This study explores sex-based differences in symptom recognition, help-seeking behaviour, and reasons for delay.
METHODS AND RESULTS: We conducted a prospective survey at a single centre from June-August, 2024. All ACS patients were eligible for inclusion. Exclusion criteria were inability to consent or lack of a clear SO time. A total of 93 patients were included. The mean age was 65±13 years, and 79% were male. Common cardiac risk factors including hypertension (60%, 56% females, 58.8% males), diabetes (31%, 40% female, 25% male), dyslipidemia (48.7%, 44% females, 44.8% males), and prior ACS (17.8%, 16% females, 14.1% males) showed no significant sex-based differences.
The median SO-FMC delay was 9.6 hours (IQR 2.02–27.82), with 9.9 hours and 8.5 hours (p=0.92) for females and males, respectively. While there were no significant sex differences in activating emergency medical services (EMS), patients who used EMS presented significantly earlier (2.9 vs. 12.8 hours, p = 0.02). Only 6.5% (4% females, 7.4% males, p=0.91) of patients presented within 1 hour, and 30.1% (32% females, 33.8% males, p=1.0) within 3 hours. Males were most likely to present within one hour compared to females (odds ratio=2.3, p=0.7).
Symptom prevalence included chest/arm/jaw pain (40% females, 36.8% males, p=1.0), nausea/vomiting (28% vs. 14.7%, p=0.33), dizziness/syncope (20% vs. 14.7%, p=0.62), dyspnea (32% vs. 19.1%, p=0.35), and clamminess (16% vs. 27.9%, p=0.12). Feeling clammy was associated with significantly earlier presentation (3.9 hours vs. 17.6 hours, p=0.007).
Reasons for delay included symptom misinterpretation (34.4%, more common in females: 56% vs. 26.5%, p=0.016), hesitation/denial (19.3%, more common in males: 22.1% vs. 12%, p=0.43), logistical barriers (15.1%), and symptom relief (4.3%). No clear reason was identified in 26.9%.
Conclusion: SO-FMC delays remain substantial in ACS. EMS use is associated with shorter delays. Sex-based behavioral differences exist: women tend to misattribute symptoms, while men more often deny them. Education focused on sex-specific symptom recognition may improve timely care and outcomes.
