Pate Amy, Leeman-Castillo Bonnie A, Krantz Mori J
Department of Family Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado.
Colorado Prevention Center, Aurora, Colorado.
Health Equity. 2019 Jun 24;3(1):287-296. doi: 10.1089/heq.2018.0046. eCollection 2019.
Women and minorities with acute myocardial infarction (AMI) often fail to recognize prodromal symptoms leading to delays in care. The objective of this study was to conduct a mixed method assessment of the impact of ethnicity on symptom description, recognition, and treatment-seeking behavior in Hispanic and non-Hispanic women before hospitalization for AMI. We explored differences in symptomatology, treatment-seeking behavior, and delay patterns among a convenience sample of 43 women diagnosed with AMI (17 Hispanic women, 26 non-Hispanic women) in seven rural and urban Colorado hospitals. We performed in-depth interviews to establish patterns (typologies) of treatment-seeking behaviors. Chart abstraction provided delay times as a function of ethnicity. Most (28/43) women reported prodromal symptoms in the weeks before their index AMI. Overall, fewer Hispanic women presented within 24 h of symptom onset (3/18, 17% vs. 15/18, 83%, <0.01). A typology of treatment-seeking behavior emerged: women who (1) recognized symptoms and promptly sought care; (2) did not recognize symptoms, yet promptly sought care; (3) recognized symptoms and promptly sought care, but providers misconstrued symptoms as noncardiac; and (4) misinterpreted symptoms due to an underlying chronic disease. Women and primary care providers often underappreciate prodromal AMI symptoms. Hispanic women are more likely to misinterpret ischemic symptoms and delay care, suggesting a need for tailored patient and provider education.
患有急性心肌梗死（AMI）的女性和少数族裔往往未能识别前驱症状，从而导致治疗延误。本研究的目的是采用混合方法评估种族对西班牙裔和非西班牙裔女性在因AMI住院前症状描述、识别及寻求治疗行为的影响。我们在科罗拉多州七家城乡医院中，对43名被诊断为AMI的女性（17名西班牙裔女性，26名非西班牙裔女性）的便利样本，探究了症状学、寻求治疗行为及延误模式的差异。我们进行了深入访谈，以确定寻求治疗行为的模式（类型）。病历摘要提供了作为种族函数的延误时间。大多数（28/43）女性在其首次AMI前几周报告了前驱症状。总体而言，在症状发作24小时内就诊的西班牙裔女性较少（3/18，17% 对15/18，83%，<0.01）。出现了一种寻求治疗行为的类型：（1）识别症状并及时寻求治疗的女性；（2）未识别症状但及时寻求治疗的女性；（3）识别症状并及时寻求治疗，但医护人员将症状误解为非心脏性症状的女性；（4）由于潜在慢性病而误解症状的女性。女性和初级保健提供者常常低估AMI前驱症状。西班牙裔女性更有可能误解缺血症状并延误治疗，这表明需要针对患者和提供者进行有针对性的教育。
