ABSTRACTS
Is There Racial Bias in the Prehospital Identification and Management of Acute Coronary Syndrome?Author: Danielle DiCesare | | Associate Authors: Yuchen Duan MD, Fitzpatrick Desmond MD, Christine Van Dillen MD, Christian Zuver MD
Objective: Acute coronary syndrome (ACS) is a leading cause of death worldwide. Much of the literature regarding the recognition and treatment of ACS has been conducted using predominantly white males, excluding racial minorities. Thus, racial minorities presenting with ACS are more frequently misdiagnosed and undertreated. This study sought to determine whether there is racial bias in the prehospital recognition and management of ACS. Methods: This retrospective analysis was performed in a large, urban county with multiple emergency medical service (EMS) agencies. The study population was comprised of adult patients who were transported by EMS and identified to have concern for ACS in the prehospital record. Race, age, gender, and past medical history were recorded directly from the EMS report. We used chi-squared analysis to assess differences in aspirin (ASA) administration and ANOVA testing to assess differences in time-to-electrocardiogram (EKG) for each race. Subgroup analyses were performed to evaluate differences in ASA administration and time-to-EKG for each race by age, gender, and history of coronary artery disease (CAD). Results: 4,093 patient encounters were analyzed, comprised of 1.5% (63) Asian, 30.6% (1,253) Black, 24.6% (1,006) Hispanic, 42.7% (1,748) White, and 0.6% (23) Other Race. Of the total population, 68.7% (2,811) received ASA and the average time-to-EKG was 457 seconds. There were significant differences in ASA administration by race; 81.0% (51) Asian, 64.6% (810) Black, 70.7% (711) Hispanic, 70.0% (1,223) White, and 69.6% (16) Other Race received ASA, respectively (P = 0.003). Time-to-EKG revealed Asian patients had an EKG performed on average in 408s compared to Black patients (466s), Hispanic patients (467s), White patients (446s), and Other Race patients (504s) (P = 0.106). Conclusion: Significant differences in rates of ASA administration among patients of different races were observed. Patients identified as Asian received ASA more frequently than other races, while patients identified as Black received ASA less frequently. Additionally, there were variations in time-to-EKG for each race, although not statistically significant and did not exceed more than two minutes. These results suggest strategies and training should be developed to ensure appropriate prehospital recognition and treatment of ACS among patients of different races.
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