Treatment Feeking Delay Among Latina and Non-latina Women with Acute Myocardial Infarction

Background: Women with acute myocardial infarction (AMI) often fail to recognize prodromal symptoms leading to delays in care. Little is known about ethnic and linguistic variation in women’s perceived symptomatology and how this impacts treatment seeking behavior and outcome.

Methods: We explored differences in symptomatology, treatment seeking behavior, and delay patterns among a sample of consecutive women diagnosed with AMI in seven rural and urban hospitals, including one academic and one safety net hospital. A diagnosis of AMI required a troponin I value exceeding the 99th percentile upper reference limit. We utilized qualitative analysis from in-depth interviews to evaluate themes in treatment seeking behavior and compared delay times as a function of ethnicity.

Results: Among the sample of 43 patients, 17 were Latina and 26 were non-Latina ethnicity. Forty-three out of 49 participated (6 declined to participate due to feeling too tired, too sick, not interested, out of state residency, or feeling it would be too difficult to participate). Most (28/43) women reported prodromal symptoms in the days and weeks prior to their index myocardial infarction. The proportion presenting within 24 hours of symptom onset was lower among Latinas vs. non-Latinas (3/18, 17% vs. 15/18, 83%, p= <.01). Spanish-speaking Latinas had longer mean delay times relative to English-speaking Latinas and non-Latinas (13 vs. 9 vs. 5 days respectively). A typology of treatment seeking behavior emerged: women who 1) recognized symptoms and promptly sought care; 2) did not recognize symptoms as AMI, yet promptly sought care; 3) recognized symptoms but providers’ misconstrued symptoms as non-cardiac; and 4) misinterpreted symptoms due to underlying chronic disease.

Conclusions: Prodromal AMI symptoms are underappreciated by women and primary care providers. In this study Latina women were more likely to misinterpret ischemic symptoms and delay seeking hospital care, suggesting a need for patient and provider education.