Persistent Sex Disparities in Pre-Hospital Delay Among Patients With STEMI Despite Overall Improvements: Findings...

Area of Science:

• Cardiology
• Public Health
• Health Disparities

Background:

• Historically, women with ST-segment-elevation myocardial infarction (STEMI) experience longer pre-hospital delays compared to men.
• The extent to which this sex disparity has narrowed in China remains an important clinical question.

Purpose of the Study:

• To investigate the trends and characteristics of pre-hospital delays in STEMI patients in China.
• To determine if sex disparities in pre-hospital delays have persisted or narrowed over time.
• To identify the components of pre-hospital delay contributing to sex differences.

Main Methods:

• Analysis of a large cohort of STEMI patients from the Chinese Cardiovascular Association Database-Chest Pain Center (2016-2023).
• Utilized multivariable quantile regression to analyze total pre-hospital delay and its components across three time periods.
• Adjusted for key demographic and clinical factors including age, comorbidities, and cardiovascular risk factors.

Main Results:

• A total of 1,104,812 STEMI patients were analyzed; 14.7% were transported by emergency medical services (EMS).
• Women consistently experienced longer pre-hospital delays than men (median difference of 24.44 minutes), with disparities widening at higher percentiles.
• While overall delays decreased, sex disparities persisted, particularly in younger (<80 years) and rural populations, driven primarily by EMS call delay.

Conclusions:

• Despite overall improvements in pre-hospital delay times for STEMI patients in China, significant sex disparities remain.
• These disparities are largely attributed to delays occurring before EMS activation, highlighting issues in symptom recognition and help-seeking behavior among women.
• Targeted strategies focusing on early symptom recognition and prompt EMS activation are crucial for women, with a need for rural-specific implementation.