Cultural perceptions of acute coronary syndrome in an urban setting: Time from onset of symptoms of ACS to arrival at emergency room

Acute Coronary Syndrome (ACS) is an important manifestation of Coronary Artery Disease – a leading cause of death. Rapid identification and treatment of ACS is critical in reducing morbidity and mortality. Yet studies show that many individuals delay 5 or more hours before seeking care. What role does culture play in symptom perception and emergent action? This study interviewed stable patients (female: 137; male: 76; mean age: 58 years) with a presumed or confirmed diagnosis of ACS arriving between October and December 2006 at two Central Brooklyn ERs. Culturally, subjects self-identified as: Caribbean (55.9%), African American (23.5%), Hispanic (8.9%), Haitian (5.2%), and other (6.5%). The majority were not US born (73.2%). Using a questionnaire, previously tested for validity and reliability, patients were interviewed within 12 hours of ER arrival regarding the most important symptoms that brought them to the hospital, symptom perception, and time of onset to time of ER arrival. The most common symptoms reported were chest pain (72.3%), and shortness of breath (11.7%). Yet, many perceived their symptoms as “gas”-related: Haitians (54%), Caribbeans (24.6%), Hispanics (15%) and African Americans (8%). In response to symptoms, many (51%) would drink a herbal remedy, “rest,” or contact family members for advice -- thereby delaying treatment. The average time from symptom onset to arrival in the ER was 13 hours. Culture and/or ethnic background clearly plays an important role in the perception of symptoms of ACS and the decision to seek urgent treatment. Such information is critical when crafting patient education programs.