Women's Health Issues
Volume 13, Issue 6 , Pages 214-221, November 2003

Presentation, delay, and contraindication to thrombolytic treatment in females and males with myocardial infarction

  • Sherry L. Grace, PhD

      Affiliations

    • University Health Network Women's Health Program, Toronto, Ontario, Canada
    • Corresponding Author InformationCorrespondence to: Sherry L. Grace, PhD, University Health Network Women's Health Program, ML2-004c, 657 University Avenue, Toronto ON, M5G 2N2 Canada; Phone: 416-340-4800 x. 6455; Fax: 416-340-4185
    • ,
  • Susan E. Abbey, MD, FRCPC

      Affiliations

    • University Health Network, Department of Psychiatry University of Toronto, Director, Program in Medical Psychiatry, Toronto, Ontario, Canada
    • ,
  • Susan Bisaillon, RN, MScN

      Affiliations

    • Trillium Health Centre, Mississauga, Toronto, Ontario, Canada
    • ,
  • Zachary M. Shnek, PhD

      Affiliations

    • Credit Valley Hospital, Department of Psychology and University of Toronto, Ontario, Canada
    • ,
  • Jane Irvine, PhD

      Affiliations

    • York University, Department of Psychology and University Health Network, Toronto, Ontario, Canada
    • ,
  • Donna E. Stewart, MD, FRCPC

      Affiliations

    • University Health Network Women's Health Program and University of Toronto, Toronto, Ontario, Canada

Received 14 April 2003; received in revised form 15 July 2003; accepted 2 September 2003.

Abstract 

Background

This study seeks to explore gender-relevant factors of medical history, sociodemographics, symptom presentation, and delay on thrombolysis administration (or recorded contraindication) in a sample of men and women with confirmed myocardial infarction (MI).

Methods

Cross-sectional examination of self and nurse-report data collected in the coronary care unit (CCU) from 12 hospitals across south-central Ontario, Canada. A total of 482 MI patients (347 males, 135 females; 63% response rate) were recruited.

Main findings

There was no gender difference in the report of chest pain (χ2(1) = 3.78, p = .052), or in prehospital delay time (median = 96.5 minutes). Thrombolysis was administered in 158 males (68.4%) and 50 females (50.0%) without reported contraindication. Females (median = 27 minutes) had a significantly longer interval between diagnostic electrocardiogram (ECG) and administration of a thrombolytic than males (median = 22, U = 3,056). No contraindication was indicated for not administering a thrombolytic (i.e., too late, risk of bleed) in approximately 40% of females. In accordance with clinical practice guidelines, thrombolysis was more often administered in participants with a shorter time interval between symptom onset and hospital arrival. For females, thrombolysis was more often administered in younger participants (Kruskal Wallis = 5.88).

Conclusions

Reducing gender, age, and socioeconomic disparities in access to thrombolysis treatment is imperative. Hospital delays with female cardiac patients may be precluding thrombolysis administration.

Keywords:  Thrombolytic therapy, Delivery of health care, Sex factors, Myocardial infarction

 

PII: S1049-3867(03)00074-4

doi:10.1016/j.whi.2003.09.002

Women's Health Issues
Volume 13, Issue 6 , Pages 214-221, November 2003

Article Tools