Pre-Hospital and Patient Delays Among Culturally and Linguistically Diverse ST-Segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention.
Heart, lung & circulation · 2026-08-20 · Observational study
Abstract
BACKGROUND: Evidence on pre-hospital delays in ST-elevation myocardial infarction (STEMI) among culturally and linguistically diverse (CALD) groups in Australia is limited. We compared patient (symptom-to-first-medical-contact) and pre-hospital (symptom-to-hospital) delays by CALD status and region in the state of Victoria, and examined factors associated with pre-hospital delay >2 hours. METHOD: This was an observational study of patients with STEMI undergoing percutaneous coronary intervention (2013-2021) using linked data (Victorian Cardiac Outcomes Registry and the Department of Health's Victorian Admitted Episodes Dataset). CALD was defined as birth in a non-English-speaking country and/or preference for a language other than English (LOTE). Logistic regression assessed associations with delays. We used 60-minute (patient) and 2-hour (pre-hospital) delay thresholds given the diminishing outcomes beyond these intervals. RESULTS: Of 11,212 patients, 31.7% were CALD (22.4% CALD patients who preferred speaking English, 9.2% CALD patients who preferred speaking a LOTE [CALD-LOTE]), 60.4% Australian-born, and 7.9% born in mainly English-speaking countries. Median patient delay (n=1,643) was similar across groups (CALD: 63 minutes; interquartile range [IQR] 27-150; non-CALD: 60 minutes; IQR 28-135). Median pre-hospital delay was similar overall (CALD-LOTE: 118 minutes; IQR 77-235; Australian-born: 120 minutes; IQR 79-223), but longer for CALD-LOTE in regional areas (180 minutes; IQR 125-290 vs 161 minutes; IQR 101-268). The 90th-percentile pre-hospital delay was 85 minutes longer among CALD-LOTE than Australian-born patients. Among CALD patients, older age, female sex, diabetes, regional residence, and out-of-hours symptom onset were associated with pre-hospital delay >2 hours. CONCLUSIONS: Patient and pre-hospital delays were broadly similar; however, subgroup differences persisted, particularly by region and at the 90th percentile of pre-hospital delay. Tailored interventions addressing high-risk groups and those with extreme delays are needed to reduce inequities and improve STEMI care.
Tags
Equity & disparities · Rural & remote · Sex & gender · Time intervals