Document Detail

Effect of a patient's sex on the timing of thrombolytic therapy.
MedLine Citation:
PMID:  8572455     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: We sought to determine whether a patient's sex independently influences the interval from emergency department arrival to the initiation of thrombolytic therapy in acute myocardial infarction (AMI). METHODS: We conducted a retrospective cohort study in two suburban EDs, one at a 929-bed tertiary care teaching hospital and the other at a 189-bed community hospital. Only patients found to be having an ST-segment-elevated AMI on their first ECG who were treated with a thrombolytic agent in the ED were eligible. We excluded patients who arrived at the ED after cardiac arrest or with a known AMI. We used as the main outcome measure the interval from ED arrival to initiation of thrombolytic therapy. Secondary outcome variables included time elapsed before ECG, interval between ECG and treatment, and 1-year mortality. RESULTS: Entry criteria were satisfied by 328 patients. The 88 women experienced a mean 23-minute delay to treatment initiation compared with men (P < .01). This observation is not accounted for by age, race, time of day, medical history, sex of the physician, type of thrombolytic agent, hospital, or triage category. The longest delays were found in women treated by female physicians, although female physicians also waited longer than male physicians to administer thrombolytic therapy to men. The mean time elapsed before the first ECG was also 6 minutes longer for women (P < .01) Women had an increased 1-year mortality rate that was fully explained by their advanced age at the time of AMI. CONCLUSION: We infer that a patient's sex may play a significant role in the observed delay in treatment for women. Our data, coupled with previously published work, strongly suggest a systematic negative effect for women in their interaction with the health care system during AMI. We suggest that variables other than systems issues affect the time elapsed before thrombolytic therapy.
R E Jackson; W Anderson; W F Peacock; L Vaught; R S Carley; A G Wilson
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  27     ISSN:  0196-0644     ISO Abbreviation:  Ann Emerg Med     Publication Date:  1996 Jan 
Date Detail:
Created Date:  1996-03-04     Completed Date:  1996-03-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  8-15     Citation Subset:  AIM; IM    
Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
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MeSH Terms
Drug Utilization Review / statistics & numerical data*
Emergency Service, Hospital / standards*
Fibrinolytic Agents / therapeutic use*
Middle Aged
Myocardial Infarction / diagnosis,  drug therapy*,  mortality
Physicians, Women
Retrospective Studies
Sex Factors
Suburban Health Services
Time Factors
Women's Health
Reg. No./Substance:
0/Fibrinolytic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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