Men who are married or in common-law relationships seek medical care sooner for heart attacks compared with single, divorced or widowed men, found a new study in CMAJ (Canadian Medical Association Journal) (pre-embargo link only) http://www.cmaj.ca/site/embargo/cmaj110170.pdf.
The benefits of marriage on health, particularly for men, have long been known. Fast, effective treatment for heart attacks is available and emergency department delays have been significantly reduced over the last few decades. However, patient delays in seeking treatment for chest pain have not improved.
This study sought to assess the affect of marital status on time from first experiencing chest pain to arrival in an emergency department. Researchers looked at data on 4403 patients in Ontario, Canada, who had heart attacks (acute myocardial infarction). The mean age was 67.3 years and 33.7% were female. Almost half of patients (46.3%) went to hospital within 2 hours, with 73.6% arriving within 6 hours. In married people, 75.3% went to hospital within 6 hours of first chest pain, compared with 67.9% single, 68.5% divorced and 70.8% widowed patients presenting during the same period.
"At the patient level, among patients with an exact time of onset of chest pain, the adjusted time saved was a remarkable half-hour. Among all the factors that had an effect in the primary outcome model, only calling an ambulance had a greater influence on the time to presentation," writes Dr. Clare Atzema, Institute for Clinical Evaluative Sciences (ICES) with coauthors. "Because cardiovascular disease is the most frequent cause of death in Canada and the Western world, the benefit at the population level is substantial."
However, women who were married or in common-law relationships did not see the same benefit from marriage in seeking faster treatment. The researchers surmise it may be because women are more likely to take the role of caregiver and to urge their spouses to seek care sooner.
"Earlier attainment of medical care may be one reason why married men have a lower risk of cardiovascular mortality than their single counterparts," conclude the authors. "Awareness of the differences in reasons for delay by sex could facilitate the development of targeted public health campaigns as a way to reduce patient-caused delay among those at risk."
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