Delayed symptom recognition and reaction with systematic sustained delays in STEMI care for women: insights from a national cohort of >10,000 patients

Abstract Background Timely reperfusion is critical in ST-segment elevation myocardial infarction (STEMI) to reduce mortality and adverse outcomes. Prior studies suggest gender-based disparities in STEMI care and outcomes, but contemporary data on time delays remain limited. This study examines gender differences in time from symptom onset to reperfusion using data from the Irish Heart Attack Audit (IHAA). Methods We conducted a retrospective analysis of STEMI patients from the IHAA between 2017 and 2023. Key time intervals—symptom onset to first medical contact (FMC), FMC to positive ECG, positive ECG to reperfusion, and symptom onset to reperfusion—were compared by gender using unadjusted and adjusted linear regression models. Due to time variables being skewed to the right, log-transformed time intervals were used as dependent variables. Adjustments were made for age, prior coronary artery disease (CAD), risk factors for CAD and direct admission to primary PCI centre. Results Among 10,229 STEMI patients (table 1), females experienced longer times at all key time stages of care delivery, with median delays of 24.5 minutes from symptom onset to FMC, 6.5 minutes from FMC to positive ECG, 5 minutes from positive ECG to reperfusion and 36 minutes for total symptom onset to reperfusion time (all p<0.001). More men sought medical help within 90 mins of symptom onset (51.4% vs 43.9%) while more women sought help after >12 hours (12.7% vs 9.7%) (figure 1). Crude analyses found a significant difference in time from symptom onset to FMC (β = 0.24, 95% CI: 0.16 to 0.32; p<0.001), FMC to positive ECG (β = 0.16, 95% CI: 0.10 to 0.22; p<0.001), positive ECG to reperfusion (β = 0.06, 95% CI: 0.03 to 0.09; p<0.001) and total time from symptom onset to reperfusion (β = 0.15, 95% CI: 0.12 to 0.19; p<0.001). Although attenuated, these disparities remained significant after adjustment for age, prior CAD, risk factors for CAD, and direct admission to primary PCI centres. Adjusted analyses found a significant difference in time from symptom onset to FMC (adjusted β = 0.19, 95% CI: 0.10 to 0.28; p<0.001), FMC to positive ECG (β = 0.15, 95% CI: 0.08 to 0.22; p<0.001), positive ECG to reperfusion (β = 0.03, 95% CI: 0.01 to 0.07; p<0.001) and total time from symptom onset to reperfusion (β = 0.12, 95% CI: 0.08 to 0.16; p<0.001). Conclusion In this large national STEMI cohort (IHAA 2017–2023), women experienced persistent delays at all key time-points from symptom onset, diagnosis to reperfusion compared to men. These findings suggest ongoing gaps in patient help-seeking behaviour and potential gender bias in provider symptom recognition. Targeted strategies are needed to improve public awareness of early symptom recognition, particularly in females, and to address possible systemic gender bias in emergency and healthcare responses to reduce treatment delay in women with STEMI. Addressing these disparities may contribute to improved outcomes in female STEMI patients.