Factors Associated with Prehospital Delay in Acute Coronary Syndrome, Among Men and Women in Karachi, Pakistan

Purpose:

 Prehospital delay in Acute Coronary Syndrome (ACS) is the time from the onset of ACS symptoms till the patient‘s arrival at the hospital‘s Emergency Department (ED). Despite the known significance of prehospital delay time (PDT) in determining clinical outcomes in ACS, quite prolonged delay times have been reported among ACS patients, globally. Gender differences in PDT and its associated factors have been explored internationally; however, this phenomenon has not been studied before in Pakistan. The current study aimed to identify gender differences in the PDT, its components, and in the factors of delay among ACS patients. The study also aimed to explore the independent correlates of the PDT, among men and women with ACS.

Methods:

 This analytical, comparative, cross-sectional study was conducted on 249 ACS patients at the Aga Khan University Hospital and at the Karachi Institute of Heart Diseases, between February and April, 2011. Data was collected through the modified ‗Response to Symptoms Questionnaire‘, and it was analyzed using comparative and regression analyses.

Results:

 The median PDT of women was found to be 7 hours, as opposed to 3.5 hours among men (P-Value: 0.001). Women had a median decision delay‘ of 3 hours, versus 1.5 hours among men (P-Value: <0.001). The median physician-to-hospital delay‘ was 4.5 hours among women, versus 2 hours among men (P-Value: 0.008). Significantly prolonged delay times were observed when patients consulted general physicians (GPs). Moreover, most women delayed due to social factors, like responses of attendants to the patients‘ symptoms‘ (P-Value: 0.002), delayed because was worried about expenses required for the treatment‘(P-Value: 0.002), and not wanting to trouble others‘(P-Value: 0.1); whereas, most men delayed due to individual related factors, like waiting for symptoms to subside‘(P-Value: <0.001), not recognizing the symptoms as cardiac‘(P-Value: <0.001), and behavioral response to the symptoms‘(P-Value: 0.08). Having anxiety‘ and lack of knowledge about symptoms‘ were associated with extended PDT among both genders.

Conclusion:

This study concludes that women delayed more than men in reaching the hospital, and both the genders had different factors of delay. The findings of the current study may be of value for other international studies on the subject. With respect to Pakistan, this possibly seminal baseline study may provide important insights for designing empirical and interventional studies, in the future.