Racial Disparities in Management and Outcomes of Out-of-Hospital Cardiac Arrest Complicating Myocardial Infarction: A National Study From England and Wales
| Autor: | Muhammad Rashid, Purvi Parwani, Michelle M. Graham, Triston B. B. J. Smith, Mohamed Dafaalla, Rachel M. Bond, Saadiq M Moledina, Ritu Thamman, Mamas A. Mamas |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
business.industry Cardiogenic shock Ethnic group RC666 medicine.disease Logistic regression R1 Out of hospital cardiac arrest RA0421 RC666-701 Internal medicine medicine National study Diseases of the circulatory (Cardiovascular) system Original Article In patient Myocardial infarction Cardiology and Cardiovascular Medicine business National audit RA |
| Zdroj: | CJC Open, Vol 3, Iss 12, Pp S81-S88 (2021) CJC Open |
| ISSN: | 2589-790X |
| DOI: | 10.1016/j.cjco.2021.09.026 |
| Popis: | Background Studies of racial disparities in care of patients admitted with an out-of-hospital cardiac arrest (OHCA) in the setting of acute myocardial infarction (AMI) have shown inconsistent results. Whether these differences in care exist in the universal healthcare system in United Kingdom is unknown. Methods Patients admitted with a diagnosis of AMI and OHCA between 2010 and 2017 from the Myocardial Ischaemia National Audit Project (MINAP) were studied. All patients were stratified based on ethnicity into a Black, Asian, or minority ethnicity (BAME) group vs a White group. We used multivariable logistic regression models to evaluate the predictors of clinical outcomes and treatment strategy. Results From 14,287 patients admitted with AMI complicated by OHCA, BAME patients constituted a minority of patients (1185 [8.3%]), compared with a White group (13,102 [91.7%]). BAME patients were younger (median age [interquartile range]) for BAME group, 58 [50-70] years; for White group, 65 [55-74] years). Cardiogenic shock (BAME group, 33%; White group, 20.7%; P < 0.001) and severe left ventricular impairment (BAME group, 21%; White group, 16.5%; P < 0.003) were more frequent among BAME patients. BAME patients were more likely to be seen by a cardiologist (BAME group, 95.9%; White group, 92.5%; P < 0.001) and were more likely to receive coronary angiography than the White group (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-1.88). The BAME group had significantly higher in-hospital mortality (OR 1.26, 95% CI 1.04-1.52) and re-infarction (OR 1.52, 95% CI 1.06-2.18) than the White group. Conclusions BAME patients were more likely to be seen by a cardiologist and receive coronary angiography than White patients. Despite this difference, the in-hospital mortality of BAME patients, particularly in the Asian population, was significantly higher. Graphical abstract |
| Databáze: | OpenAIRE |
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