Myocardial infarction: psychosocial aspects, gender differences and impact on pre-hospital delay.

AIM: This paper is a report of a study to explore gender differences in psychosocial aspects in the year prior to first-time myocardial infarction, and the association between these aspects and pre-hospital delay.
BACKGROUND: The time from symptom onset to hospital admission is critical for patient survival; therefore influences on pre-hospital delay are of interest. The prevalence of stressful psychosocial factors is higher among patients before acute myocardial infarction than among healthy controls.
METHOD: Patients diagnosed with first-time acute myocardial infarction were recruited from five Norwegian hospitals over a 13-month period in 2003-2004. Of 738 eligible patients, 149 women and 384 men completed a self-administered questionnaire (response rate 72%).
FINDINGS: Depression, high family stress, high work stress and major life events had no statistically significant impact on patient delay or total pre-hospital delay. Depression, sleep disturbances and high family stress were reported among more women than men in the year prior to the event. Women and men aged 65 years and younger were more likely to report major depression and major life events than those older than 65. Low education and low partner education predicted prolonged patient delay in men but not in women. Low partner education also predicted prolonged total pre-hospital delay in men.
CONCLUSION: The process between symptom onset and hospital admittance is complex, and more knowledge about factors influencing this process is vital to reduce pre-hospital delay. Significant others should be included in information-giving in relation to myocardial infarction as they seem to play a vital role in patients' decision-making processes.