Racism Is Not a Factor in Door-to-electrocardiogram Times of Patients With Symptoms of Acute Coronary Syndrome: A
Martha H Mackay1,2,3, Pamela A Ratner1, Gerry Veenstra1
1University of British Columbia, Vancouver, British Columbia, Canada.
Insights
This study found no racial or ethnic differences in emergency department care for acute coronary syndrome (ACS) in Canada. However, women experienced longer door-to-electrocardiogram times, indicating a need for process improvements in ACS care.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Equity
Background:
- Racial and ethnic disparities in acute coronary syndrome (ACS) care and outcomes are documented.
- Patient-specific factors partially explain these outcome differences.
- Variations in emergency department (ED) triage and care for suspected ACS based on race/ethnicity require investigation.
Purpose of the Study:
- To investigate racial/ethnicity-based variations in the initial ED triage and care of patients with suspected ACS in Canadian hospitals.
- To identify potential disparities in early ACS management.
- To inform targeted interventions for improving ACS care equity.
Main Methods:
- Prospective enrollment of ED patients with suspected ACS across three Canadian hospitals.
- Standardized interviews to collect data on symptoms, treatment-seeking, and self-reported racial/ethnic identity (White, South Asian, Asian, Other).
- Clinical parameters reviewed via chart, with door-to-electrocardiogram (D2ECG) time as the primary outcome, analyzed using multivariable regression models.
Main Results:
- Of 448 participants, 48% identified as White, 26% as South Asian, 19% as Asian, and 8% as Other.
- No significant differences in D2ECG time were observed between White participants and other racial/ethnic groups.
- Women experienced statistically significantly longer D2ECG times (13.4%) compared to men in adjusted models.
Conclusions:
- No evidence of racial/ethnicity-based differences in early ED care for suspected ACS was found in this Canadian urban setting.
- Female patients face longer D2ECG times, highlighting a potential area for process improvement in ACS care.
- Further research may explore underlying reasons for sex-based disparities in ACS care delivery.
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 behavior 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 one university-affiliated and two community hospitals. Trained research assistants administered a standardized 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 two 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 and 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.
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