Navigation Links
Disparities in heart attack treatment may begin in the emergency room

The well-documented disparities in cardiac care may begin almost as soon as patients arrive at hospital emergency rooms. In a study published in Academic Emergency Medicine, Massachusetts General Hospital (MGH) researchers report that African-American and Hispanic patients assessed for chest pain were less likely than white patients to be categorized as requiring immediate care, despite a lack of significant differences in symptoms. Such practices directly violate American College of Cardiology and American Heart Association guidelines specifying immediate electrocardiogram (ECG) examination for any patient with chest pain.

"In this first nationally representative sample of emergency room patients, we found persistant racial, gender and insurance-coverage based differences in triage categorization and cardiac testing," says Lenny Lopez, MD, MPH, of the Mongan Institute for Health Policy at MGH, the study's lead author. "Emergency room triage is the critical step that determines the whole cascade of clinical decisons and testing that happens next, so if patients are misclassfied on arrival, they won't receive the care they need when they need it."

Many studies have documented racial, ethnic and gender-based differences in the likelihood that patients with cardiac symptoms will receive procedures like cardiac catheterization, angioplasty and coronary artery bypass surgery. The current study was designed to evaluate whether the initial, emergency-room triage decision a quick assessment to determine which patients need to be seen immediately and which can wait has a role in these disparities. The researchers evaluated data from the National Hospital Ambulatory Health Care Survey of Emergency Departments (NHAMCS-ED) covering 1997-2006, including the age, gender, race/ethnicity and insurance status of patients coming to the surveyed hospital departments (EDs) with chest pain.

The NHAMCS-ED uses four triage categories: emergent for patients who should be seen immediately, urgent for those who can wait 15 to 60 minutes, semiurgent for patients who can wait one to two hours, and nonurgent for those who can wait two hours or longer. For purposes of this study, patients in the first two categories were classified as emergent, and those in the last two as nonemergent. The total sample of 235,000 ED visits over the 10-year period included almost 22,000 patients arriving with chest pain or related symptoms such as tightness or burning in the chest area.

Among patients who received an ED diagnosis of probable myocardial infarction (heart attack), there were no significant differences in initial symptoms between racial or ethnic groups. As previous studies have found, women eventually diagnosed with heart attack were less likely to report chest pain than were men. But among all those presenting with chest pain, African American and Hispanic patients were significantly less likely than white patients to be triaged as emergent. In addition, African American and Hispanic patients, as well as those who were uninsured or covered by Medicaid, were less likely to receive such basic cardiac testing procedures as ECG, cardiac monitoring or measurement of cardiac enzymes. Factors such as whether patients arrived by ambulance or the day of the week on which they were seen did not make any difference.

"These differences in ED triage may be important drivers of disparities in testing, procedures and eventual outcomes," says Lopez. "If you are misclassified at this first step, you're less likely to get the ECG because your condition is not considered urgent. In the long term, you may have an even more severe heart attack that could have been prevented if intervention had occurred earlier. This is not an area of medicine where there is a lack of clarity about what we are supposed to do, so quality improvement strategies need to focus on 100 percent guideline-driven triage management for every single patient."


Contact: Sue McGreevey
Massachusetts General Hospital

Related medicine news :

1. NIH celebrates 10 years of research into health disparities
2. Obesity rates decline for many adolescents but disparities worsen
3. Demographic disparities found among children with frequent ear infections
4. Disparities remain a challenge in health care says American College of Physicians
5. Study reveals causes of survival disparities based on insurance among rectal cancer patients
6. Study finds racial, ethnic disparities in family-centered care for kids with special health needs
7. Pay-for-performance programs may worsen medical disparities, study finds
8. NIH awards $10 million to Rush University Medical Center to address health disparities
9. American Human Development Project Releases 'A Century Apart,' Revealing Alarming Disparities in Well-Being Among U.S. Racial and Ethnic Groups
10. Cancer health disparities research highlighted at AACR 101st Annual Meeting 2010
11. New study implicates health care utilization, over biology, in colorectal cancer disparities
Post Your Comments:
(Date:11/30/2015)... ... November 30, 2015 , ... Olympic Gold ... are collaborating with brands across various categories through traditional and social media marketing ... an elite group of Gold Medal Moms who can connect with today’s most ...
(Date:11/30/2015)... ... , ... The National Association of Professional Women (NAPW) honors ... Circle. She is recognized with this prestigious distinction for leadership in estate sales and ... than 850,000 members and over 200 operating Local Chapters. , “I’m pleased to welcome ...
(Date:11/30/2015)... ... November 30, 2015 , ... Being a caregiver for someone ... Maryland Health Care System, the Caregiver Support Program promotes the health and wellbeing ... job. Seventy-four percent report that their role as a caregiver has created marital ...
(Date:11/30/2015)... ... November 30, 2015 , ... According to research by the ... dental technicians to be certified or obtain continuing education. To increase awareness of ... Your Mouth?” campaign to inform dentists that the technicians they trust could lack ...
(Date:11/30/2015)... ... November 30, 2015 , ... The Museum ... summer, ushering in a new era of publicly accessible automated technology. Now, by ... continue to offer guests an up-close look at the shuttle at MOSI’s main ...
Breaking Medicine News(10 mins):
(Date:11/30/2015)... Express Scripts (NASDAQ: ESRX ) today announced it will ... access to a low-cost alternative to Daraprim (pyrimethamine) , ... recently priced out of reach for people with HIV, pregnant ... --> --> Imprimis is offering a compounded ... acid) for $1 per capsule for people whose pharmacy benefit is ...
(Date:11/30/2015)... SINGAPORE , Nov. 30, 2015  QT Vascular ... Vascular", and together with its subsidiaries, TriReme Medical LLC ... global company engaged in the design, assembly and distribution ... of vascular disease, is pleased to announce that a ... Court of Appeals for the Federal Circuit ("Federal ...
(Date:11/30/2015)... , Nov. 30, 2015   Royal ... announced the launch of Radiology Solutions, a fully ... Radiology Solutions comprises customized, data-driven practice management approaches ... to help radiology practices improve care delivery and ... 2015 Radiological Society of North America Annual Meeting ...
Breaking Medicine Technology: