Abstract 13019: Young Women with Depression Wait Longer for Acute Coronary Syndrome Diagnosis

Abstract

Introduction: Despite improvements in the management of ACS, sex differences in mortality persist, specifically among younger patients. Delays in treatment have been implicated in explaining worse outcomes in women. To date, the impact of sex and psychological risk factors on trajectory of care in younger patients hospitalized with ACS has not been assessed.

Hypotheses: We assessed whether young women with ACS experienced longer time from “door to-” ECG, balloon, and needle, and fewer reperfusion procedures (thrombolytics, primary PCI) and non-primary PCI compared to young men. We also assessed the extent to which symptoms (Sx) of depression (Hospital Anxiety and Depression Scale) were associated with delays and use of procedures in women and men.

Methods: This analysis included 857 ACS participants (≤ 55 years, 27% of women) recruited into the GENESIS PRAXY study, from 26 sites in Canada, the US and Switzerland. In-hospital data, and depressive Sx were collected through self-report questionnaires and chart review. Linear and logistic regressions were used to assess the impact of sex, and depressive Sx on treatment delays and procedures.

Results: The median age was 49 years (interquartile range [IQR]: 45-53), and the proportions of high depressive Sx (HADS ≥ 8) were 31% and 26% in women and men. Women had longer door-to-ECG time than men (median =18 vs.10 min, adjusted estimate = 0.96 hrs, 95% CI: 0.01-1.93). Moreover, this delay was greater in women with high level of depressive Sx (median = 21 min, IQR: 7-58), when compared to women with less depressive Sx (median = 16 min, IQR: 4-46, p for interaction=0.02). Among patients with STEMI, there was also a trend for women to undergo less reperfusion procedures (85% vs. 92%, adjusted OR = 0.57, 95% CI: 0.29-1.09). In patients with NSTEMI/UA, women tended to have less non-primary PCI (36% vs. 39%, adjusted OR = 0.71, 95% CI: 0.49-1.01). There was no effect of sex on “time to-” balloon or needle.

Conclusion: Depressed women who present to hospital with premature ACS experience longer delays in initial diagnostic work-up. Recognizing that female sex and depressive Sx may delay diagnosis and decrease the utilization of reperfusion represents an opportunity to reduce post-ACS mortality through more appropriate access to care.