| Background: Delay before treatment affects outcomes for patients with acute coronary syndrome (ACS). Previous studies have suggested that women are delayed more than men. We sought to determine whether this gender disparity exists in a Massachusetts cohort using Emergency Medical Services (EMS) and whether gender associated factors mediate or modify delay.;Methods and Results: We collected data on all adult patients with symptoms suggestive of ACS who contacted EMS in two Massachusetts cities. Outcomes including total pre-hospital time in EMS and its subdivision into on-scene time and transport time and occurrence of delay in EMS (>15 minutes longer than mean pre-hospital time) were compared with potential factors affecting delay including patient age, history of coronary artery disease or diabetes, primary complaint, language barrier, time of presentation, disease severity and acquisition of and abnormalities in a 12-lead electrocardiogram (ECG). Multivariable regression models were used to adjust risk factors.;Among 6,837 patients, 3,484(51%) were women and 3,353(49%) men. Women took longer (23.8 +/- 9.0 min. vs. 22.4 +/- 7.7 min., p < 0.0001) and were more likely to have delays (11.4% 9.0%, p = 0.001). After multivariable adjustment, women took 1.2 minutes longer (95% CI: 0.8 - 1.6, p < 0.0001) and were more likely to be delayed (OR = 1.2, CI = 1.0-1.4, p = 0.02) than men. The extra time was mainly on-scene.;Conclusions: Women with ACS are more likely to be delayed in arriving to the emergency department when attended by EMS, even after adjustment for other factors that contribute to delay. No specific risk factors were found that predisposed certain women to delays. Investigation of on-scene care seems warranted. |
