The association between symptom onset characteristics and prehospital delay in women and men with acute coronary syndrome.
Sahereh Mirzaei, Alana Steffen, Karen Vuckovic and 4 others
PMID 31510786WHAT IT FOUND
Prehospital delay did not differ between women and men with ACS, but gradual onset was tied to longer delay than abrupt onset.
Key findings
01Median prehospital delay was 3.47 h for women and 4.09 h for men, and the difference was not significant.
02Abrupt onset had shorter median delay than gradual onset: women 2.4 h versus 11.7 h, and men 2.8 h versus 7.17 h.
03Not being insured and gradual onset were associated with longer delay; STEMI diagnosis and ambulance arrival were associated with shorter delay.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Some patients could not recall accurately when symptoms began, and delay was abstracted from the medical record. The study queried activity in the 48 h before admission, and the paper notes there is no general agreement about how long before onset an activity counts as a trigger. Patients with missing delay (45) or onset (6) data were excluded. The sample was English-speaking, at least 21, and excluded heart failure exacerbation, hemodialysis transfer, dysrhythmia referral, or cognitive impairment. Only patients diagnosed with ACS were analyzed. People who presented with possible ACS but were not diagnosed are not represented.
Declared interests
The authors declared no conflict of interest. The article is listed as having NIH extramural research support.
The easy way to misread this
Do not conclude that gradual onset is a less urgent problem. The paper found longer delay with gradual onset, but it also says patients should be counseled that gradual and abrupt onset are both emergencies.