Pre-Hospital and Patient Delays Among Culturally and Linguistically Diverse ST-Segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

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 90 th -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 90 th 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.