Women and older patients with atypical presentations of ST-segment elevation myocardial infarction (STEMI) experience greater delays in diagnosis and treatment activation in emergency departments, according to the results of a study led by Gemma Berga Congost from the Nursing Research Group at the Research Institute of Hospital de la Santa Creu i Sant Pau – IIB Sant Pau and a nurse at the same hospital.
The study, which included 330 patients with STEMI admitted to the Emergency Department of Hospital de Sant Pau, revealed that age over 65 and presentation of the first medical contact outside the Emergency Department were associated with an increase in treatment activation time. In addition, women over 65 showed the longest activation time. The results highlight the need to develop strategies to reduce the time to initiate treatment in these specific patient groups.
ST-segment elevation myocardial infarction is more common in men than in women, and the average age of patients admitted for myocardial infarction in Spain is around 65 years. “In contrast, the average age of women is 10 years older than that of men, probably due to the protective effect of estrogen,” emphasizes this expert.
The delay in diagnosis experienced by these groups “may be attributable to the atypical symptoms they most frequently present. Therefore, in addition to typical symptoms, other manifestations identified in our registry should be considered in order to establish an early diagnosis.”
It is also important to note that both women and the elderly have a lower perception of risk, which delays the request for medical assistance, resulting in delayed diagnosis and treatment.
The study from IIB Sant Pau has also identified that age over 65 is a predictor of delay in diagnosis and provides new data regarding the age and gender gap. As Berga points out, “there is no positive association between gender and age in patients under 65. However, if the age is over 65, it is observed that women have a longer emergency-activation time than men.”
These findings underline the importance of addressing the specific needs of these patient groups to improve activation time. Developing targeted strategies to accelerate activation time in these subgroups is crucial to improve the quality of care provided in the Emergency Department.
Gemma Berga Congost, Maria Antonia Martinez Momblan, Jonatan Valverde Bernal, Adrián Márquez López, Judit Ruiz Gabalda, Joan Garcia-Picart, Mireia Puig Campmany, Salvatore Brugaletta. Association of sex and age and delay predictors on the time of primary angioplasty activation for myocardial infarction patients in an emergency department. Heart & Lung (2023). https://doi.org/10.1016/j.hrtlng.2022.10.014