A new study adds to an established body of evidence showing that poor people and Medicaid beneficiaries are slower to be treated for heart attacks than counterparts with more money or better insurance. Part of the problem lies with the delayed recognition of heart-attack symptoms in poorer areas, researchers from the University of North Carolina-Chapel Hill said.

Investigators found that just 36% of poorer patients arrived at the hospital within the two-hour window deemed critical for many treatments after a heart attack. Some 42% took from two to 12 hours to get treatment, while 22% arrived at the hospital between 12 and 72 hours after the event.

Researchers took health insurance status, distance from the hospital, emergency medical services, diabetes, high blood pressure and other factors into account.

The continued delay “suggests a need for increased recognition of and rapid response to acute myocardial infarction symptoms within these populations,” report authors wrote, noting that delay times have not improved for many years. They said interventions that should be considered include community education and awareness campaigns, targeted interventions by healthcare professionals with patients with known coronary heart disease, and better promoting emergency medical services.

The study involved the review of medical records of more than 6,740 men and women hospitalized due to a heart attack from 1993 to 2002.