Impact of name-based implicit bias on time to diagnosis and outcomes in ST-elevation myocardial infarction
Dorian Garin1, Sonja Lehmann1, Wesley Bennar1
1Cardiology, University & Hospital, Fribourg, Switzerland.
Insights
Patients with uncommon surnames faced longer delays in ST-elevation myocardial infarction (STEMI) diagnosis. However, treatment following diagnosis was equitable, with no long-term differences in major adverse cardiac and cerebrovascular events (MACE).
Area of Science:
- Cardiology
- Health Equity
- Biostatistics
Background:
- Marginalized patient groups often experience diagnostic delays for ST-elevation myocardial infarction (STEMI), even with established fast-track protocols.
- This study investigates potential diagnostic delays in STEMI patients with phonetically uncommon surnames within a fast-track network.
Purpose of the Study:
- To determine if patients with phonetically uncommon surnames experience delays from first medical contact (FMC) to STEMI diagnosis compared to patients with common surnames.
- To assess the impact of surname phonetic uncommonness on FMC-to-balloon time and infarct size markers.
- To evaluate long-term major adverse cardiac and cerebrovascular events (MACE) based on surname phonetic commonness.
Main Methods:
- Utilized data from the Fast-Track Protocol for ST-Elevation Myocardial Infarction prospective registry (June 2008–November 2024).
- Classified patient surnames as phonetically common or uncommon using standardized phonetic matching against population data.
- Employed generalized linear models and Cox regression to analyze diagnostic times, treatment times, infarct size, and MACE outcomes.
Main Results:
- Patients with uncommon surnames had significantly prolonged FMC-to-diagnosis (mean difference +16.8 min) and FMC-to-balloon times (mean difference +17.5 min).
- A higher proportion of patients with uncommon names exceeded recommended FMC-to-balloon time thresholds (90 min and 120 min).
- No significant differences were found in diagnosis-to-balloon time, peak creatine kinase levels, or MACE at 30 days and 5 years.
Conclusions:
- Phonetically uncommon surnames are associated with significant diagnostic delays in STEMI patients within a fast-track system.
- Despite initial diagnostic delays, protocol-driven care post-diagnosis ensures equitable treatment and similar long-term MACE outcomes.
Background:
Patients with marginalised characteristics experience delayed ST-elevation myocardial infarction (STEMI) diagnosis despite fast-track protocols. We aimed to determine whether patients with phonetically uncommon surnames in our community experience delays from first medical contact (FMC) to STEMI diagnosis compared with patients with common surnames within an established fast-track network.
Methods:
The Fast-Track Protocol for ST-Elevation Myocardial Infarction prospective registry enrolled consecutive STEMI patients from June 2008 to November 2024. Patient surnames were classified as phonetically common or uncommon using standardised phonetic matching against Canton Fribourg population data. Generalised linear models examined FMC-to-diagnosis time, FMC-to-balloon time and infarct size markers. Cox regression assessed major adverse cardiac and cerebrovascular events (MACE) at 30 days, 1 year and 5 years.
Results:
Among 1208 patients, 284 (23.5%) had phonetically uncommon surnames. Patients with uncommon names experienced prolonged FMC-to-diagnosis time (59.4±87.6 vs 40.6±37.6 min; mean difference +16.8 min; p=0.009) and FMC-to-balloon time (116.8±90.5 vs 97.5±45.7 min; mean difference +17.5 min; p=0.016). Patients with uncommon names were significantly more likely to exceed the 90 min FMC-to-balloon threshold (39.2% vs 48.4%; p=0.010) and the 120 min threshold (16.4% vs 23.5%; p=0.018). Diagnosis-to-balloon time remained unaffected (p>0.80). Peak creatine kinase muscle-brain showed non-significant elevation (mean difference +52.0 U/L; p=0.077). No differences were observed in MACE at 30 days and 5 years between patients with common and uncommon names.
Conclusions:
Patients with phonetically uncommon surnames experienced significant STEMI diagnostic delays within an efficient fast-track network. Protocol-driven care following diagnosis operated equitably, leading to no difference in long-term MACE.
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