Association Between Sex and Prehospital Delay in Patients With Acute Myocardial Infarction: A Cross-Sectional Analysis of the National Hospital Ambulatory Medical Care Survey, 2006-2020

Background: Prehospital delay in acute myocardial infarction (AMI) remains an important factor affecting timely care. Differences in delay by sex have been reported, but findings are not consistent across studies. Understanding these patterns using nationally representative data is important for clinical and public health planning. Objective: The objective of this study was to evaluate the association between sex and delayed presentation, approximated using triage acuity at emergency department arrival, among patients with AMI using nationally representative emergency department data. Methods: A cross-sectional study was conducted using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2006 to 2020. The study included 1,229 adult visits, representing 6,344,820 weighted emergency department visits. Prehospital delay was defined using triage acuity. Survey-weighted logistic regression was used to assess the association between sex and delay, adjusting for age category, race and ethnicity, and insurance type. Results: Female patients had lower odds of delayed presentation compared to males, with an adjusted odds ratio of 0.69, a 95% CI of 0.51 to 0.93, and a p = 0.016. Insurance type was associated with delay, with lower odds observed among privately insured patients (adjusted odds ratio 0.52, 95% CI 0.32 to 0.85, p = 0.009) and other insurance (adjusted odds ratio 0.42, 95% CI 0.26 to 0.69, p < 0.001). Age and race were not significantly associated with delay. Conclusion: Prehospital delay varies by sex and insurance status. These findings support continued efforts to improve timely presentation and address barriers to care.