Sex Disparities in First Medical Contact of Patients with Suspected Acute Coronary Syndrome Using Telemedicine Technology

Background: Reducing door-to-balloon time may not reduce mortality, but reducing the time from symptom onset to first medical contact (FMC) may alone improve patient outcomes. The purpose of this study was to focus on analyzing sex differences in FMC call delay and its trend over the decades in patients with suspected acute coronary syndrome (ACS). Methods: Large private telemedicine data in patients with suspected ACS were used to investigate time delay in contacting a telemedicine call center. We identified 24,592 calls to a primary call center of patients with anginal symptoms and first electrocardiogram (ECG), using mobile 12-lead ECG devices. For the purpose of the current analysis, we included the first call of 14,420 patients for whom demographic, clinical ECG data were available. Results: First mobile ECG changes included suspected S-T Segment (ST) elevation in 2,220 (16%) cases, ST depression in 3,143 (22%) cases, or both in 685 (5%) patients. There were 6,721 (47%) calls to the center within less than 1 h of symptom onset. Chest pain, dyspnea, heart rate, male sex, absence of diabetes mellitus, early time period of the study, and ischemic ST segment changes on the first ECG were all independently associated with the increased likelihood of contacting the center within less than 1 h of symptom onset to FMC (p < 0.01 for all). Conclusions: Both chest pain and ischemic ECG changes were sex dependent for early medical contact, as such factors were significant among men (p = 0.001 and p = 0.024, respectively), but not among women (p = 0.024). The later time period of the study was associated with a shorter time delay among women more than that of men (p = 0.014). Women with prehospital chest pain or ischemic ST segment changes tend to seek medical help later than men. Temporal trends show attenuation of this sex disparity, with more women presenting earlier in the last decade.