Abstract 4068: Long Working Hours and Delay in Seeking Care during Acute Coronary Events in U.S. and Japanese Samples
Objective: Timely reperfusion therapy with fibrinolytic therapy or primary percutaneous coronary intervention reduces infarct size and adverse clinical consequences. However, prolonged prehospital delay (symptom onset to hospital arrival) continues to be a problem. Numerous studies have examined factors associated with prehospital delay. Yet, the association between job characteristics and delay has never been examined. The purpose of the study was to examine the association between working hours/job strain and duration of prehospital delay in employed patients with acute coronary syndrome (ACS) in the United States (U.S.) and Japan.
Methods: In this cross-sectional study, a total of 234 consecutive patients (Americans n= 148 and Japanese n =86) admitted with ACS and who worked more than 20 hours/week were recruited. A structured interview was conducted while patients were still in a hospital to assess symptom onset time, ambulance use, number of working hours/week, and job strain. In the U.S. sample, the mean age was 50.7 (SD ± 7.3) years and 74.1% of the sample were men. In the Japanese sample, the mean age was 56.7 (SD ± 10.8) years and 92.5% of the sample were men.
Results: In the U.S. sample, the median prehospital delay time was 4.4 hours, while in the Japanese sample, the median prehospital delay time was 8.3 hours. Average working hours/week in the U.S. and Japanese samples were 47.3 (SD ± 10.8) and 55.3 hours (SD ± 21.5) hours. In multivariate analysis, the interaction between working hours and nationality on log transformed prehospital delay time was significant (p = 0.001) after controlling for potential confounding factors. Among the Japanese sample, for every one hour increase in working hours/week, prehospital delay increased by approximately 4% with a 95% confidence interval from 1.0% to 10% (p = .003). However, among the U.S. sample, no association was found (-2.0%, 95%CI: -4.0% to 0, p = 0.08).
Conclusions These findings support the need for worksite educational programs in Japan that focus on the appropriate responses to acute cardiac symptoms.
This research has received full or partial funding support from the American Heart Association, AHA Western States Affiliate (California, Nevada & Utah).