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Women's Prehospital Delay Associated With Myocardial Infarction: Does Race Really Matter?

McSweeney, Jean C. PhD, RN, FAHA, FAAN; Lefler, Leanne L. PhD, APN, CCRN; Fischer, Ellen P. PhD; Naylor, Albert Joe Jr BSN, APN; Evans, Laura K. BSN, APN

The Journal of Cardiovascular Nursing: July-August 2007 - Volume 22 - Issue 4 - p 279-285
doi: 10.1097/01.JCN.0000278958.98124.6e
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Background/Research Objective: Well-documented disparities in cardiovascular health account for approximately one third of the difference in life expectancy between blacks and whites. Mortality from cardiovascular disease is greater among black women than among white women, and black women report longer delays in treatment seeking following onset of symptoms of acute myocardial infarction (AMI). Despite this disparate burden, there is little race-specific data on correlates of delay for black or white women. This secondary data analysis compares duration and correlates of delay in treatment seeking by race following onset of AMI symptoms.

Subjects/Methods: We analyzed self-report data from 509 black and 500 white women, interviewed 4 to 6 months after AMI, using multivariable logistic and linear regression.

Results/Conclusions: Median delay time was nonsignificantly shorter for black than for white women (1.0 vs 1.5 hours). Equal proportions of black and white women (57% vs 54%) sought treatment within 2 hours of symptom onset. In multivariable analyses, correct attribution of symptoms to AMI was a significant predictor of treatment seeking within 2 hours of symptom onset for black and white women (odds ratios = 2.79 and 3.86, respectively); eligibility for public insurance was a significant predictor for black women only (odds ratio = 2.3). Common comorbidities, AMI risk factors, and other demographics were not significantly associated with delay time. Insurance coverage and the correct attribution of symptoms to cardiac causes are substantial and modifiable predictors of delay in seeking treatment of AMI.

Jean C. McSweeney, PhD, RN, FAHA, FAAN Professor, College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Ark.

Leanne L. Lefler, PhD, APN, CCRN Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Ark.

Ellen P. Fischer, PhD Associate Professor, Departments of Psychiatry & of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Ark. Research Health Scientist, Central Arkansas Veterans Healthcare System, Little Rock, Ark.

Albert Joe Naylor, Jr Statistical Programmer, Department of Psychiatry & Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.

Laura K. Evans, BSN, APN Doctoral Student, Research Assistant, College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Ark.

The National Institute of Nursing Research supported this work with 2 grants, 1 RO1 NR04908 and 1 R01 NR05265.

The authors of this article have no significant ties, financial or otherwise, to any company that might have an interest in the publication of this educational activity.

Corresponding author Jean C. McSweeney, PhD, RN, FAHA, FAAN, College of Nursing, 4301 West Markham St, Slot 529, Little Rock, AR 72205 (e-mail: jcmcsweeney@uams.edu).

© 2007 Lippincott Williams & Wilkins, Inc.