Hospital delay in South Asian patients with acute ST-elevation myocardial infarction in the UK

Abstract

While the reasons for ethnic differences in AMI-related hospital delay are likely to be multifactorial and complex, there is an urgent need to promote change in both the South Asian patient (delays in arrival) and their treatment (delays in intervention).

The association between ethnicity and delay in seeking medical care for chest pain

“…69,70,71,72,77 The descriptive summary of all included studies is available as Appendix V. All selected studies were classified as level 3 and 4 (level 3 clevel 4b) according to the JBI Levels of Evidence for Effectiveness (Appendix VIII).…”

“…The outcomes were measured in two ways: quantitative time measured in hour units 68,69,[73][74][75][76][77] (Table 3) and categories of time [70][71][72] (Table 4). Appropriate statistical analyses were undertaken in the studies, t-test for continuous variables and Chi-square tests for categorical variables.…”

“…Appropriate statistical analyses were undertaken in the studies, t-test for continuous variables and Chi-square tests for categorical variables. Additionally, 70% of the included studies 68,69,71,72,[74][75][76] had a large sample size at a national level, only three studies 70,73,77 enrolled less than 1000 participants. The ten studies were performed over periods of time ranging from one year 76 to ten years.…”

“…77 The mean age of participants of the ten reviewed studies varied from 59 73 Data source and study size Data from the ten included studies were collected from large databases and large university hospitals. Eight studies included participants from databases at a national level, including the Myocardial Ischaemic National Audit Project (MINAP) 76 , National Registry of Myocardial Infarction (NRMI) 68,69,74 , British Cardiovascular Intervention Society (BCIS) 77 , Atherosclerosis Risk in Community (ARIC) 71 , the Cooperative Cardiovascular Project 72 and Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation (CRUSADE). 75 The remaining two studies 70,73 included participant from local hospitals.…”

Quality of Life in a mixed ethnic population after myocardial infarction

“…There are also ethnic differences in healthcare-seeking behaviour and the way doctors manage South Asian people with chest pain [8][9][10]. South Asian people in the UK with myocardial infarction (MI) experience disproportionately greater delays with respect to diagnosis and treatment [11,12], are less likely to use an ambulance [5], they wait longer for specialist referral [13,14] and are less likely to be treated with thrombolysis [15,16], or receive exercise testing [17] or angiography [18,19]. This is in addition to the many general barriers to accessing healthcare that face many South Asian people with heart disease [20,21].…”