University of British Columbia, Vancouver, British Columbia, Canada.
BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada.
Acad Emerg Med. 2019 May;26(5):491-500. doi: 10.1111/acem.13569. Epub 2018 Oct 21.
Investigators have identified important racial identity/ethnicity-based differences in some aspects of acute coronary syndrome (ACS) care and outcomes (time to presentation, symptoms, receipt of coronary angiography/revascularization, repeat revascularization, mortality). Patient-based differences such as pathophysiology and treatment-seeking behavior account only partly for these outcome differences. We sought to investigate whether there are racial identity/ethnicity-based variations in the initial emergency department (ED) triage and care of patients with suspected ACS in Canadian hospitals.
We prospectively enrolled ED patients with suspected ACS from one university-affiliated and two community hospitals. Trained research assistants administered a standardized interview to gather data on symptoms, treatment-seeking patterns, and self-reported racial/ethnic identity: "white," South Asian" (SA), "Asian," or "Other." Clinical parameters were obtained through chart review. The primary outcome was door-to-electrocardiogram (D2ECG) time. ECG times were log-transformed and two linear regression models, controlling for important demographic, system, and clinical factors, were fit.
Of 448 participants, 214 (48%) reported white identity, 115 (26%) SA, 83 (19%) Asian, and 36 (8%) "Other." Asian respondents were younger and more likely to report initial discomfort as "low" and be accompanied by family; respondents identifying as "Other" were more likely to report initial discomfort as "high." There was no difference in D2ECG time between white participants and all other groups, but there were statistically significant differences by sex: women had longer D2ECG times than men. Exploring more specific racial identities revealed similar findings: no significant differences between the white, SA, Asian, and other groups, while sex (women had 13.4% [95% confidence interval, 0.81%-27.57%] longer D2ECG times) remained statistically significantly different in the adjusted models.
Although racial/ethnicity-based differences in aspects of ACS care have been previously identified, we found no differences in the current study of early ED care in a Canadian urban setting. However, female patients experience longer D2ECG times, and this may be a target for process improvements.
研究人员已经在急性冠状动脉综合征（ACS）护理和结果的某些方面发现了重要的种族身份/民族差异（表现时间、症状、接受冠状动脉造影/血运重建、再次血运重建、死亡率）。基于患者的差异，如病理生理学和寻求治疗的行为，仅能部分解释这些结果差异。我们试图调查在加拿大医院中，疑似 ACS 患者在急诊部（ED）分诊和初始护理方面是否存在种族身份/民族差异。
我们前瞻性地招募了来自一所大学附属医院和两所社区医院的疑似 ACS 的 ED 患者。经过培训的研究助理对患者进行了标准化访谈，以收集症状、寻求治疗模式和自我报告的种族/民族身份信息：“白人”、“南亚裔”（SA）、“亚裔”或“其他”。通过病历回顾获取临床参数。主要结局指标是从进入急诊部到心电图（D2ECG）的时间。ECG 时间进行对数转换，并拟合了两个控制重要人口统计学、系统和临床因素的线性回归模型。
在 448 名参与者中，214 名（48%）报告为白人身份，115 名（26%）为 SA，83 名（19%）为亚裔，36 名（8%）为“其他”。亚裔受访者更年轻，更有可能报告最初的不适为“低”，并伴有家人陪同；报告为“其他”的受访者更有可能报告最初的不适为“高”。白人参与者与所有其他组之间的 D2ECG 时间没有差异，但按性别存在统计学差异：女性的 D2ECG 时间比男性长。探索更具体的种族身份也得出了类似的发现：在白人、SA、亚裔和其他组之间没有显著差异，而在调整后的模型中，性别（女性 D2ECG 时间长 13.4%[95%置信区间，0.81%-27.57%]）仍然存在统计学差异。
尽管先前已经确定了 ACS 护理方面的种族/民族差异，但在加拿大城市环境中对早期 ED 护理的当前研究中，我们没有发现差异。然而，女性患者的 D2ECG 时间更长，这可能是一个需要改进的过程。
