The Impact of Race on the Acute Management of Chest Pain

Arvind Venkat, James Hoekstra, Christopher Lindsell, Dawn Prall, Judd E. Hollander, Charles V. Pollack, Deborah Diercks, J. Douglas Kirk, Brian Tiffany, Frank Peacock, Alan B. Storrow, W. Brian Gibler

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objectives: African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and noninterventional treatment. Methods: Data on adults with chest pain (N = 7,935) presenting to eight emergency departments (EDs) were evaluated from the Internet Tracking Registry of Acute Coronary Syndromes. Groups were selected from final ED diagnosis: 1) acute myocardial infarction (AMI), n = 400; 2) unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), n = 1,153; and 3) nonacute coronary syndrome chest pain (non-ACS CP), n = 6,382. American College of Cardiology/American Heart Association guidelines for AMI and UA/NSTEMI were used to evaluate racial disparities with logistic regression models. Odds ratios (ORs) were adjusted for age, gender, guideline publication, and insurance status. Non-ACS CP patients were assessed by comparing electrocardiographic (ECG)/laboratory evaluation, medical treatment, admission rates, and invasive and noninvasive testing for coronary artery disease (CAD). Results: African Americans with UA/NSTEMI received glycoprotein IIb/IIIa receptor inhibitors less often than whites (OR, 0.41; 95% CI = 0.19 to 0.91). African Americans with non-ACS CP underwent ECG/laboratory evaluation, medical treatment, and invasive and noninvasive testing for CAD less often than whites (p < 0.05). Other nonwhites with non-ACS CP were admitted and received invasive testing for CAD less often than whites (p < 0.01). African Americans and other nonwhites with AMI underwent catheterization less frequently than whites (OR, 0.45; 95% CI = 0.29 to 0.71 and OR, 0.40; 95% CI = 0.17 to 0.92, respectively). A similar disparity in catheterization was noted in UA/NSTEMI therapy (OR, 0.53; 95% CI = 0.40 to 0.68 and OR, 0.68; 95% CI = 0.47 to 0.99). Conclusions: Racial disparities in acute chest pain management extend beyond cardiac catheterization. Poor compliance with recommended treatments for ACS may be an explanation.

Original languageEnglish (US)
Pages (from-to)1199-1208
Number of pages10
JournalAcademic Emergency Medicine
Volume10
Issue number11
DOIs
StatePublished - Nov 2003

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Chest Pain
Odds Ratio
Unstable Angina
African Americans
Coronary Artery Disease
Myocardial Infarction
Acute Coronary Syndrome
Cardiac Catheterization
Catheterization
Hospital Emergency Service
Logistic Models
Guidelines
Therapeutics
Platelet Glycoprotein GPIIb-IIIa Complex
Insurance Coverage
Acute Pain
Pain Management
Internet
Registries
Publications

Keywords

  • Acute coronary syndromes
  • Cardiac catheterization
  • Chest pain
  • Glycoprotein IIb/IIIa platelet receptor inhibitor
  • Race

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Venkat, A., Hoekstra, J., Lindsell, C., Prall, D., Hollander, J. E., Pollack, C. V., ... Gibler, W. B. (2003). The Impact of Race on the Acute Management of Chest Pain. Academic Emergency Medicine, 10(11), 1199-1208. https://doi.org/10.1197/S1069-6563(03)00490-1

The Impact of Race on the Acute Management of Chest Pain. / Venkat, Arvind; Hoekstra, James; Lindsell, Christopher; Prall, Dawn; Hollander, Judd E.; Pollack, Charles V.; Diercks, Deborah; Kirk, J. Douglas; Tiffany, Brian; Peacock, Frank; Storrow, Alan B.; Gibler, W. Brian.

In: Academic Emergency Medicine, Vol. 10, No. 11, 11.2003, p. 1199-1208.

Research output: Contribution to journalArticle

Venkat, A, Hoekstra, J, Lindsell, C, Prall, D, Hollander, JE, Pollack, CV, Diercks, D, Kirk, JD, Tiffany, B, Peacock, F, Storrow, AB & Gibler, WB 2003, 'The Impact of Race on the Acute Management of Chest Pain', Academic Emergency Medicine, vol. 10, no. 11, pp. 1199-1208. https://doi.org/10.1197/S1069-6563(03)00490-1
Venkat A, Hoekstra J, Lindsell C, Prall D, Hollander JE, Pollack CV et al. The Impact of Race on the Acute Management of Chest Pain. Academic Emergency Medicine. 2003 Nov;10(11):1199-1208. https://doi.org/10.1197/S1069-6563(03)00490-1
Venkat, Arvind ; Hoekstra, James ; Lindsell, Christopher ; Prall, Dawn ; Hollander, Judd E. ; Pollack, Charles V. ; Diercks, Deborah ; Kirk, J. Douglas ; Tiffany, Brian ; Peacock, Frank ; Storrow, Alan B. ; Gibler, W. Brian. / The Impact of Race on the Acute Management of Chest Pain. In: Academic Emergency Medicine. 2003 ; Vol. 10, No. 11. pp. 1199-1208.
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abstract = "Objectives: African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and noninterventional treatment. Methods: Data on adults with chest pain (N = 7,935) presenting to eight emergency departments (EDs) were evaluated from the Internet Tracking Registry of Acute Coronary Syndromes. Groups were selected from final ED diagnosis: 1) acute myocardial infarction (AMI), n = 400; 2) unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), n = 1,153; and 3) nonacute coronary syndrome chest pain (non-ACS CP), n = 6,382. American College of Cardiology/American Heart Association guidelines for AMI and UA/NSTEMI were used to evaluate racial disparities with logistic regression models. Odds ratios (ORs) were adjusted for age, gender, guideline publication, and insurance status. Non-ACS CP patients were assessed by comparing electrocardiographic (ECG)/laboratory evaluation, medical treatment, admission rates, and invasive and noninvasive testing for coronary artery disease (CAD). Results: African Americans with UA/NSTEMI received glycoprotein IIb/IIIa receptor inhibitors less often than whites (OR, 0.41; 95{\%} CI = 0.19 to 0.91). African Americans with non-ACS CP underwent ECG/laboratory evaluation, medical treatment, and invasive and noninvasive testing for CAD less often than whites (p < 0.05). Other nonwhites with non-ACS CP were admitted and received invasive testing for CAD less often than whites (p < 0.01). African Americans and other nonwhites with AMI underwent catheterization less frequently than whites (OR, 0.45; 95{\%} CI = 0.29 to 0.71 and OR, 0.40; 95{\%} CI = 0.17 to 0.92, respectively). A similar disparity in catheterization was noted in UA/NSTEMI therapy (OR, 0.53; 95{\%} CI = 0.40 to 0.68 and OR, 0.68; 95{\%} CI = 0.47 to 0.99). Conclusions: Racial disparities in acute chest pain management extend beyond cardiac catheterization. Poor compliance with recommended treatments for ACS may be an explanation.",
keywords = "Acute coronary syndromes, Cardiac catheterization, Chest pain, Glycoprotein IIb/IIIa platelet receptor inhibitor, Race",
author = "Arvind Venkat and James Hoekstra and Christopher Lindsell and Dawn Prall and Hollander, {Judd E.} and Pollack, {Charles V.} and Deborah Diercks and Kirk, {J. Douglas} and Brian Tiffany and Frank Peacock and Storrow, {Alan B.} and Gibler, {W. Brian}",
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AU - Venkat, Arvind

AU - Hoekstra, James

AU - Lindsell, Christopher

AU - Prall, Dawn

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AU - Pollack, Charles V.

AU - Diercks, Deborah

AU - Kirk, J. Douglas

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N2 - Objectives: African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and noninterventional treatment. Methods: Data on adults with chest pain (N = 7,935) presenting to eight emergency departments (EDs) were evaluated from the Internet Tracking Registry of Acute Coronary Syndromes. Groups were selected from final ED diagnosis: 1) acute myocardial infarction (AMI), n = 400; 2) unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), n = 1,153; and 3) nonacute coronary syndrome chest pain (non-ACS CP), n = 6,382. American College of Cardiology/American Heart Association guidelines for AMI and UA/NSTEMI were used to evaluate racial disparities with logistic regression models. Odds ratios (ORs) were adjusted for age, gender, guideline publication, and insurance status. Non-ACS CP patients were assessed by comparing electrocardiographic (ECG)/laboratory evaluation, medical treatment, admission rates, and invasive and noninvasive testing for coronary artery disease (CAD). Results: African Americans with UA/NSTEMI received glycoprotein IIb/IIIa receptor inhibitors less often than whites (OR, 0.41; 95% CI = 0.19 to 0.91). African Americans with non-ACS CP underwent ECG/laboratory evaluation, medical treatment, and invasive and noninvasive testing for CAD less often than whites (p < 0.05). Other nonwhites with non-ACS CP were admitted and received invasive testing for CAD less often than whites (p < 0.01). African Americans and other nonwhites with AMI underwent catheterization less frequently than whites (OR, 0.45; 95% CI = 0.29 to 0.71 and OR, 0.40; 95% CI = 0.17 to 0.92, respectively). A similar disparity in catheterization was noted in UA/NSTEMI therapy (OR, 0.53; 95% CI = 0.40 to 0.68 and OR, 0.68; 95% CI = 0.47 to 0.99). Conclusions: Racial disparities in acute chest pain management extend beyond cardiac catheterization. Poor compliance with recommended treatments for ACS may be an explanation.

AB - Objectives: African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and noninterventional treatment. Methods: Data on adults with chest pain (N = 7,935) presenting to eight emergency departments (EDs) were evaluated from the Internet Tracking Registry of Acute Coronary Syndromes. Groups were selected from final ED diagnosis: 1) acute myocardial infarction (AMI), n = 400; 2) unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), n = 1,153; and 3) nonacute coronary syndrome chest pain (non-ACS CP), n = 6,382. American College of Cardiology/American Heart Association guidelines for AMI and UA/NSTEMI were used to evaluate racial disparities with logistic regression models. Odds ratios (ORs) were adjusted for age, gender, guideline publication, and insurance status. Non-ACS CP patients were assessed by comparing electrocardiographic (ECG)/laboratory evaluation, medical treatment, admission rates, and invasive and noninvasive testing for coronary artery disease (CAD). Results: African Americans with UA/NSTEMI received glycoprotein IIb/IIIa receptor inhibitors less often than whites (OR, 0.41; 95% CI = 0.19 to 0.91). African Americans with non-ACS CP underwent ECG/laboratory evaluation, medical treatment, and invasive and noninvasive testing for CAD less often than whites (p < 0.05). Other nonwhites with non-ACS CP were admitted and received invasive testing for CAD less often than whites (p < 0.01). African Americans and other nonwhites with AMI underwent catheterization less frequently than whites (OR, 0.45; 95% CI = 0.29 to 0.71 and OR, 0.40; 95% CI = 0.17 to 0.92, respectively). A similar disparity in catheterization was noted in UA/NSTEMI therapy (OR, 0.53; 95% CI = 0.40 to 0.68 and OR, 0.68; 95% CI = 0.47 to 0.99). Conclusions: Racial disparities in acute chest pain management extend beyond cardiac catheterization. Poor compliance with recommended treatments for ACS may be an explanation.

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