Blog | Friday, July 22, 2011

QD: News Every Day--Married men more likely to seek earlier heart attack care

Till death do us part, indeed! Women encourage their spouses to seek earlier treatment for medical care for myocardial infarctions, even when they're not present when chest pain starts.

Marriage by erix! via Flickr and a Creative Commons licenseResearchers hypothesized that a spouse, including common law relationships, would encourage quicker treatment even if the woman wasn't there, because wives were more likely than husbands to assume a caregiver role and encourage quicker treatment.

They established the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study, a retrospective cohort of a population based sample of 4,403 eligible patients with acute myocardial infarction from Ontario, Canada, who sought care from 86 eligible hospitals from April 2004 to March 2005. In Canada, marital status is recorded for every emergency patient.

Patients were excluded if they had transferred facilities, had missing data for onset of pain, or had no chest pain upon presentation. The primary analysis broke down patients who presented more than six hours after chest pain. They recorded any quality or nature of chest pain. A secondary analysis that looked at results 2, 6 or more than 12 hours after the initial onset of pain was done on 3,840 patients for whom the exact time of onset of chest pain was known. Results appeared online July 18 at CMAJ, the journal of the Canadian Medical Association.

Being married was associated with lower odds of delayed presentation (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.30 to 0.71, P less than 0.001) than among single patients. Among men, the OR was 0.35 (95% CI 0.21 to 0.59, P less than 0.001), and among women marital status was not significant (OR 1.36, 95% CI 0.49-3.73, P=0.55).

For all patients meeting the secondary analysis criteria, being married was associated with reduced odds of presentation after 2, 6 or 12 hours of delay (OR 0.45, 95% CI 0.31 to 0.64, P less than 0.001), relative to being single. For men, the odds ratio was 0.39 (95% CI 0.25 to 0.62, P less than 0.001), and was not significant for women (OR 0.72, 95% CI 0.35 to 1.48, P=0.37).

Researchers noted that among patients with a known exact time of the onset of chest pain, the adjusted time saved was a "remarkable" half-hour. Only calling an ambulance had a greater influence on the time to presentation.

Researchers noted that, unlike other studies, they included only patients who had chest pain. "Because women are more likely to have atypical symptoms, the association of delayed presentation with female sex may disappear once women without chest pain are excluded."