Sex differences in help-seeking behaviour among patients presenting with acute coronary syndrome

Abstract Background Acute coronary syndrome (ACS) is a leading global cause of morbidity and mortality. While door-to-balloon times have improved, delays from symptom onset (SO) to first medical contact (FMC) remain unchanged, likely due to complex patient behaviours. Furthermore, there may be sex-specific differences in how ACS symptoms are perceived and the subsequent help-seeking behaviour. Purpose To understand delays in seeking care for ACS, focusing on sex differences in symptom recognition, help-seeking behaviour, and reasons for delay. Methods A prospective survey at a single centre from June-August 2024 was conducted. All ACS patients were eligible for inclusion. Patients were excluded if unable to provide consent, did not speak English or did not have a clear SO time. Patients completed a survey assessing SO and FMC times, symptom perception, and reasons for delay. Chart review for medical history was completed. Results Of the 93 included patients, mean age was 65±13 years and 79% were male (M). Cardiac risk factors including hypertension (60%, 56% female (M) vs 59% M), diabetes (31%, 40% F vs 25% M), dyslipidemia (49%, 44% F vs 45% M) showed no significant sex-based differences. The median SO-FMC delay was 9.58 hours (IQR 2.02–27.82), with 9.87 hours and 8.48 hours (p=0.92) for females and males, respectively. While there were no significant sex differences in emergency medical services (EMS) use, patients that used EMS presented earlier (2.9 vs 12.75 hours, p=0.02). Only 6.45% (4% F vs 7% M, p=0.91) of patients presented within 1 hour and 30% (32% F vs 34% M, p=1.0) within 3 hours. Males were most likely to present within one hour (odds ratio=1.9, p=0.7) compared to females. Patients experienced a variety of symptoms such as chest/arm/jaw pain (40% F vs 37% M, p=1.0), nausea/vomiting (28% F vs 15% M, p=0.33), dizziness and syncope (20% F vs 15% M, p=0.62), shortness of breath (32% F vs 19% M, p=0.35), and feeling clammy and sweating (16% F vs 28% M, p=0.12). In study population, feeling clammy resulted in statistically significant earlier presentations (3.85 vs 17.58 hours, p=0.007). The most common reasons for delayed presentation were symptom misinterpretation as non-cardiac (34%, 56% F vs 27% M, p=0.016) and hesitation/denial (19%, 12% F vs 22% M, p=0.43). Other reasons included logistical barriers (15%, 12% F vs 16% M, p=0.8), and immediate symptom relief (4%, 0% F vs 6% M, p=0.5). In 27% of patients, there was no identifiable reason. Conclusions Significant SO-FMC delays persist in ACS patients. Sex-based differences exist in patient’s behaviour when presenting with ACS, with different symptoms prompting male and female patients to seek help. The most common reason for delay in females seems to be symptoms misinterpretation while denial is a major factor in male patients’ delays. Targeted education on sex-specific ACS symptom recognition may help reduce delays and improve timely medical care.