RESUMEN
PURPOSE: Previous studies have shown longer delays from symptom onset to hospital presentation (S2P time) in women than men with acute myocardial infarction. The aim of this study is to understand the reasons for delays in seeking care among women and men presenting with an ST-Segment Elevation Myocardial Infarction (STEMI) through a detailed assessment of the thoughts, perceptions and patterns of behavior. PATIENTS/METHODS AND RESULTS: A total of 218 patients with STEMI treated with primary angioplasty at four New York City Hospitals were interviewed (24% female; Women: 68.7 ± 13.1 years and men: 60.7 ± 13.8 years) between January 2009 and August 2012. A significantly larger percentage of women than men had no chest pain (62% vs 36%, p<0.01). Compared to men, a smaller proportion of women thought they were having a myocardial infarction (15% vs 34%, p=0.01). A larger proportion of women than men had S2P time >90 minutes (72% of women vs 54% of men, p= 0.03). Women were more likely than men to hesitate before seeking help, and more women than men hesitated because they did not think they were having an AMI (91% vs 83%, p=0.04). Multivariate regression analysis showed that female sex (Odds Ratio: 2.46, 95% CI 1.10-5.60 P=0.03), subjective opinion it was not an AMI (Odds Ratio 2.44, 95% CI 1.20-5.0, P=0.01) and level of education less than high school (Odds ratio 7.21 95% CI 1.59-32.75 P=0.01) were independent predictors for S2P >90 minutes. CONCLUSION: Women with STEMI have longer pre-hospital delays than men, which are associated with a higher prevalence of atypical symptoms and a lack of belief in women that they are having an AMI. Greater focus should be made on educating women (and men) regarding the symptoms of STEMI, and the importance of a timely response to these symptoms.
RESUMEN
BACKGROUND: Prior studies have shown that misinterpretation of the electrocardiogram (ECG) can lead to inappropriate diagnoses and clinical decisions. This may be particularly true during the first month of postgraduate training. This study was designed to assess proficiency in ECG interpretation among residents at the start of their internal medicine (IM) residency. METHODS: Ten ECGs were selected from IM department teaching files. All were representative of conditions that a starting IM resident should be able to identify. The ECGs had 1 correct primary diagnosis and a short list of secondary findings as determined by 2 cardiologists who reviewed them independently. Fifty-two first-year IM residents were given copies and asked to record their interpretations and an assessment of their certainty in each interpretation. Certainty was scored on a scale of 0 to 4 (0 representing a guess and 4 representing 100% certainty). Two blinded, independent graders scored each interpretation on a scale of 0 to 2 (0 = incorrect, 1 = partially correct, 2 = correct). RESULTS: Overall, only half of all ECGs were read correctly. For the most critical diagnoses, the mean scores were as follows: 1.73/2.0 for acute myocardial infarction, 1.5/2.0 for atrial flutter, 1.11/2.0 for ventricular tachycardia, and 0.23/2.0 for complete heart block. The average level of certainty recorded by all participants was low at 18.5 of a maximum of 40. CONCLUSIONS: Internal medicine residents at the beginning of their residency training demonstrated low overall proficiency in interpreting ECGs and self-perceived confidence. Nearly all residents felt that their training was insufficient. These findings emphasize the need for improved and more effective training in ECG interpretation for physicians starting residency.