(VP016) CAN THE THEORY OF PLANNED BEHAVIOUR EXPLAIN WHY FEMALES DELAY SEEKING TREATMENT FOR ACUTE CORONARY SYNDROME SYMPTOMS AND GUIDE PRIMARY CARE EDUCATION?

Background: Cardiovascular disease is the second leading cause of death in Canadian women, and research has well-demonstrated sex and gender disparities in the pathophysiology, risk factors, clinical presentations, and management of acute coronary syndrome (ACS). Notably, acute myocardial infarction often presents with atypical symptoms in females and leads to worse outcomes than in males. Despite this knowledge, under-recognition, under-diagnosis, and under-treatment for ACS in females persist. Experts argue that females’ delayed treatment-seeking behaviour contributes significantly to this phenomenon, and the current educational approach focused on symptom recognition alone is insufficient to prevent this delay. Therefore, this scoping review aims to analyze females’ delayed treatment-seeking behaviour for ACS symptoms and provide primary care providers with recommendations for patient education.

METHODS AND RESULTS: A systematic search in PubMed and CINAHL identified 498 studies, and 23 were selected for analysis to answer the research question: For female patients who are experiencing ACS symptoms, what are the contributing factors that prevent or delay treatment-seeking? Using Ajzen’s Theory of Planned Behaviour as a framework, multi-factorial reasons were identified: 1) belief that females are not at risk for ACS and lack of knowledge of typical and atypical symptoms of ACS in females, leading to misattribution and self-diagnosis of their symptoms as non-cardiac and non-serious; 2) culturally- and socially-constructed altruistic gender role of females towards social responsibility taking priority before their own health; 3) desire to maintain control and independence, and not wanting to bother others; 4) support people’s dismissal or misinterpretation of symptoms; and, 5) limited resources in rural areas and cultural laws hindering women from leaving home alone in select countries.

Conclusion: It is evident that behavioural, normative and control beliefs, attitudes, social norms, and perceived behavioural control greatly influence females’ cognitive decision-making process to seek treatment for ACS symptoms. The clinical implication of the findings is noteworthy. The following 'ACT' acronym is presented to guide primary care providers in educating female patients at risk of ACS: Advise on the risk of ACS. Counsel that many women delay seeking medical attention during a heart attack due to caretaking obligations or a desire to maintain control, and emphasize that treatment-seeking is the best way to continue caring for the loved ones and maintaining their physical, social and personal integrity in the long term. Teach both typical and atypical symptoms of ACS in females and to act immediately if it occurs.