Beyond the Beats: Disparities in Prehospital Cardiac Care

While disparities in care between demographic groups (e.g., race/ethnicity, gender, age) have been demonstrated across the spectrum of health care, limited research exists for ST-segment elevation myocardial infarction (STEMI) patients in the prehospital setting.

The purpose of this study was to describe disparities specific to the prehospital care of STEMI using data from a large urban fire-based emergency medical services (EMS) system.

Electronic patient care records for all STEMI activations from 02/01/2020 to 09/01/2022 were reviewed. National benchmark variables evaluated included administration of analgesia (either fentanyl or nitroglycerin), nitroglycerin administration, aspirin administration, scene time, transport time, STEMI alert time, and electrocardiogram (ECG) time. Analyses were conducted using logistic and linear regression.

A total of 888 patients were evaluated. The average age was 63.9 years, 575 (63.9%) were male, and 479 (53.9%) were White. Black patients were less likely than White patients to be administered analgesia, as were patients 75 years and older compared to patients 60-74. Female patients were less likely than male patients to receive nitroglycerin or aspirin. Both Black and Hispanic patients were less likely to receive aspirin compared to White patients. Differences in age groups emerged for two-time metrics: Patients 75 years and older had longer scene times and STEMI alert times than patients 60-74. None of the demographic variables were statistically significant predictors of transport time or ECG time.

This evaluation of comprehensive demographic information from a large fire-based EMS system revealed disparities among STEMI patients in analgesia administration, specifically aspirin and nitroglycerin based on gender and race/ethnicity.