title: Age and sex differences in duration of prehospital delay in patients with acute myocardial infarction: a systematic review.
abstract: BACKGROUND
  Coronary heart disease is the leading cause of morbidity and mortality in American men and women. Although there have been dramatic changes in the management of patients hospitalized with acute myocardial infarction (AMI) over the past several decades, a considerable proportion of patients with AMI continue to delay seeking medical care in a timely manner. This review provides an overview of the published literature that has examined age and sex differences in extent of prehospital delay in patients hospitalized with AMI.
  
  
  RESULTS
  A systematic review of the literature from 1960 to 2008, including publications that provided data on duration of prehospital delay in patients hospitalized with AMI, was conducted. A total of 44 articles (42 studies) were included in the present analysis. The majority of studies showed that in patients hospitalized with AMI, women and older persons were more likely to arrive at the hospital later than men and younger persons. Several factors associated with duration of prehospital delay, including sociodemographic, medical history, clinical, and contextual characteristics differed according to sex.
  
  
  CONCLUSIONS
  The elderly and women were more likely to exhibit longer delays in seeking medical care after the development of symptoms suggestive of AMI compared with other groups. Further research is needed to more fully understand the reasons for delay in these vulnerable groups.
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA.
authors.forename: Hoa L
authors.initials: HL
authors.lastname: Nguyen
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014187:Transportation of Patients