Clinical Investigation
Acute Ischemic Heart Disease
Gender differences in time to presentation for myocardial infarction before and after a national women's cardiovascular awareness campaign: A temporal analysis from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation (CRUSADE) and the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network–Get with the Guidelines (NCDR ACTION Registry–GWTG)

https://doi.org/10.1016/j.ahj.2010.04.017Get rights and content

Background

In 2001-2002, the American Heart Association and National Heart, Lung, and Blood Institute initiated national campaigns with the aim of increasing women's awareness of their risk of heart disease, with particular focus on women aged 40 to 60 years. Our aim is to determine if these women's awareness campaigns were associated with a reduction in the time to hospital presentation for myocardial infarction in women.

Methods

The study population comprised patients who presented with a non–ST-segment elevation myocardial infarction in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines Registry and the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network–Get with the Guidelines registry. Analysis was done based on the introduction of the educational intervention: preintervention 2002-2003, intermediate 2004-2005, and post 2006-2007.

Results

Of 125,161 patients, 50,162 (40.1%) are women. The median time from symptom onset to presentation was significantly longer in women than men: 3 hours (interquartile range 1.4-7.6) versus 2.8 hours (interquartile range 1.3-7.2, P < .0001), a difference that remained significant after adjusting for clinical characteristics. There was no measurable reduction in the time from symptom onset to presentation over the period of the awareness campaigns: post- versus preintervention period (−0.18%, 95% CI −3.02% to 2.74%). After adjustment for covariates, women aged 40 to 60 years had a 3.46% longer time to presentation than men (95% CI 1.06-5.92, P = .005).

Conclusions

There was no reduction in time from symptom onset to hospital presentation for myocardial infarction patients since national awareness campaigns in women were initiated, and a significant gender gap remains.

Section snippets

Population

The Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the American College of Cardiology/AHA Guidelines (CRUSADE) quality improvement initiative included patients with ischemic symptoms at rest within 24 hours of presentation and high-risk features (ST-segment depression, transient ST-segment elevation, and/or positive cardiac biomarkers). The National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes

Results

The overall study comprised 125,161 patients with 50,162 (40%) women and 74,999 (60%) men. The median age of the overall cohort was 69 years (IQR 57-79). The overall cohort was predominantly white. (Table I). In addition, 24% of the patients presented with signs of heart failure; and 31% had ST depression on their presenting electrocardiogram (Table I).

The cohort included pooled data from 2 distinct registries. When comparing patients from the ACTION-GWTG (16,017 patients) and CRUSADE registry

Discussion

In this contemporary cohort of patients with NSTEMI evaluated during the AHA's “Go Red for Women” and the NHLBI's “Heart Truth” campaigns., we noted no change in time to presentation in men or women over the 6-year period. Both of these campaigns focused on increasing awareness of cardiovascular risk and not specifically on improving time to presentation. However, given the significant resources expended on patient education, our findings regarding the lack of change in time to presentation

Conclusion

Despite evidence that current educational efforts have significantly increased awareness of the risk factors associated with heart disease, we did not find a decrease in time from symptom onset to presentation in patients with NSTEMI. Future studies should focus on identifying the best mechanism of emphasizing the need for early action once symptoms concerning for a cardiac event are recognized.

Disclosures

Presented in abstract form at the American Heart Association, New Orleans, LA, November 2008.

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