Effect of Marriage on Duration of Chest Pain Associated With Acute Myocardial Infarction Before Seeking Care

Study Questions:

Is marital status a predictor of the duration of chest pain endured by patients with acute myocardial infarction (AMI) before they seek care, and does a patient’s sex modify the effect?

Methods:

A retrospective, population-based cohort analysis was conducted in patients with AMI admitted to 96 acute care hospitals in Ontario, Canada, from April 2004 to March 2005. Patients without chest pain were excluded. Multivariable regression analyses were utilized to assess marital status in relation to delayed presentation to the hospital (more than 6 hours from onset of pain), both overall and stratified by sex. In patients who reported the exact duration of chest pain, the effect of marital status on the delay in seeking care was assessed.

Results:

Among 4,403 eligible patients with an AMI, the mean (standard deviation) age was 67.3 (13.6) years, and 1,486 (33.7%) were women. About 15% had a previous percutaneous coronary intervention or coronary artery bypass graft surgery, 70% arrived on a weekday, and about two thirds arrived between 8 a.m. and 4 p.m. A total of 46.3% presented to a hospital within 2 hours, and 3,240 (73.6%) presented within 6 hours. In patients for whom the exact onset of chest pain was known, the adjusted time to presentation was 30.4 minutes less (95% confidence interval [CI], 62.6 minutes less to 1.8 minute more) than the time for their single counterparts. Overall, 75.3% of married patients, 67.9% of single patients, 68.5% of divorced patients, and 70.8% of widowed patients presented within 6 hours of the onset of chest pain. Being married was associated with lower odds of delayed presentation (odds ratio [OR], 0.46; 95% CI, 0.30-0.71; p < 0.001) relative to being single. Among men, the OR was 0.35 (95% CI, 0.21-0.59; p < 0.001), whereas among women, the effect of marital status was not significant (OR, 1.36; 95% CI, 0.49-3.73; p = 0.55). Among men, other factors that reduced the odds of a delay in presentation included South Asian ethnicity, calling an ambulance, and night-time presentation, whereas older age was associated with delay. Among women, being divorced was associated with increased odds of delayed presentation, relative to being single, as were older age and a history of depression. In contrast, calling an ambulance and higher income level were associated with lower odds of delayed presentation among women.

Conclusions:

Among men experiencing an AMI with chest pain, being married was associated with significantly earlier presentation for care, a benefit that was not observed for married women. Earlier presentation for medical care appears to be one reason for the observed lower risk of cardiovascular death among married men, relative to their single counterparts.

Perspective:

It has been long held, that in general, women may be more likely than men to take the role of caregiver and to advise their spouses to seek early medical assessment. In a similar analysis, married men were found to be more likely to attend cardiac rehab than single men, an advantage not found in married women. The impact of age of the spouse on the results was not presented.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Myocardial Infarction, Spouses, Marriage, Widowhood, Marital Status, Chest Pain, Canada, Ontario, Coronary Artery Bypass, Percutaneous Coronary Intervention, Caregivers


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