title: Prehospital care pathway delays: gender and myocardial infarction.
abstract: OBJECTIVE
  This paper reports the findings of a study that identified gender specific prehospital care pathway delays amongst Irish women and men with myocardial infarction.
  
  
  BACKGROUND
  Women are more likely to experience a poorer prognosis than their male counterparts following hospitalization for myocardial infarction, yet research shows that women continue to experience prehospital care pathway delays.
  
  
  METHODS
  A 1-year prospective census was carried in six major academic teaching hospitals in Dublin, Ireland in 2001-2002. A total of 277 (31%) female and 613 (69%) male patients with confirmed myocardial infarction were included in the study.
  
  
  RESULTS
  Women were more likely to experience prolonged 'initial symptom-onset to A&E delays' (14 hours vs. 2.8 hours P < 0.0001), and 'intense symptom-onset to A&E delays' (3.1 hours vs. 1.8 hours , P < 0.0001), i.e. arrival at a hospital accident and emergency department. Advancing age was associated with greater prehospital delays (P < 0.0001), whilst patients with private health insurance had shorter delays than public patients (without private health insurance) or those with medical cards (entitling them to means-tested medical benefits) (P = 0.001). Patients who drove themselves by car to hospital had shorter median prehospital times than those arriving by any other admission mode (P < 0.0001), whilst those referred by their general practitioner had longer delays than those who were self-referred (5 hours vs. 1.7 hours, P < 0.0001).
  
  
  CONCLUSIONS
  Female gender, advancing age, referral source, insurance status and mode of transport to hospital are independent factors contributing to prehospital patient delays. Nurses who care for patients with coronary artery disease have a unique opportunity to educate people about the most appropriate action to be taken in the event of experiencing symptoms.
authors.affiliation: School of Nursing and Midwifery, Trinity College, Dublin, Ireland. sodonne@tcd.ie
authors.forename: Sharon
authors.initials: S
authors.lastname: O'Donnell
authors.forename: Sarah
authors.initials: S
authors.lastname: Condell
authors.forename: Cecily
authors.initials: C
authors.lastname: Begley
authors.forename: Tony
authors.initials: T
authors.lastname: Fitzgerald
mesh_terms: D000367:Age Factors; D000368:Aged; D004630:Emergencies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011446:Prospective Studies; D012737:Sex Factors; D013997:Time Factors