Racism is not a factor in door-to-ECG times of patients with symptoms of acute coronary syndrome: A prospective, observational study.
Acad Emerg Med. 2018 Sep 17;:
Authors: Mackay MH, Ratner PA, Veenstra G, Scheuermeyer FX, Grubisic M, Ramanathan K, Murray C, Humphries KH
BACKGROUND: Investigators have identified important racial-identity/ethnicity-based differences in some aspects of acute coronary syndrome (ACS) care and outcomes (time to presentation, symptoms, receipt of coronary angiography/revascularization, repeat revascularization, mortality). Patient-based differences such as pathophysiology and treatment-seeking behaviour account only partly for these outcome differences. We sought to investigate whether there are racial-identity/ethnicity-based variations in the initial emergency department (ED) triage and care of patients with suspected ACS in Canadian hospitals.
METHODS: We prospectively enrolled ED patients with suspected ACS from 1 university-affiliated and 2 community hospitals. Trained research assistants administered a standardised interview to gather data on symptoms, treatment-seeking patterns, and self-reported racial/ethnic identity: "White", South Asian" (SA), "Asian" or "Other". Clinical parameters were obtained through chart review. The primary outcome was door-to-electrocardiogram (D2ECG) time. ECG times were log-transformed and 2 linear regression models, controlling for important demographic, system and clinical factors, were fit,.
RESULTS: Of 448 participants, 214 (48%) reported White identity; 115 (26%) SA; 83 (19%) Asian, and 36 (8%) Other. Asian respondents were younger, more likely to report initial discomfort as "low" and be accompanied by family; respondents identifying as "Other" were more likely to report initial discomfort as "high". There was no difference in D2ECG time between White participants and all other groups, but there were statistically significant differences by sex: women had longer D2ECG times than men. Exploring more specific racial identities revealed similar findings: no significant differences between the White, SA, Asian and "Other" groups, while sex (women had 13.4% [95% confidence interval, 0.81 - 27.57%] longer D2ECG times) remained statistically significantly different in the adjusted models.
CONCLUSION: Although racial/ethnicity-based differences in aspects of ACS care have been previously identified, we found no differences in the current study of early ED care in a Canadian urban setting. However, female patients experience longer D2ECG times, and this may be a target for process improvements. This article is protected by copyright. All rights reserved.
PMID: 30222233 [PubMed - as supplied by publisher]