Race differences in cardiac testing rates for patients with chest pain in a multisite cohort

Abstract

BackgroundIdentifying and eliminating racial health care disparities is a public health priority. However, data evaluating race differences in emergency department (ED) chest pain care are limited.MethodsWe conducted a secondary analysis of the High‐Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification (STOP‐CP) cohort, which prospectively enrolled adults with symptoms suggestive of acute coronary syndrome without ST‐elevation from eight EDs in the United States from 2017 to 2018. Race was self‐reported by patients and abstracted from health records. Rates of 30‐day noninvasive testing (NIT), cardiac catheterization, revascularization, and adjudicated cardiac death or myocardial infarction (MI) were determined. Logistic regression was used to evaluate the association between race and 30‐day outcomes with and without adjustment for potential confounders.ResultsAmong 1454 participants, 42.3% (615/1454) were non‐White. At 30 days NIT occurred in 31.4% (457/1454), cardiac catheterization in 13.5% (197/1454), revascularization in 6.0% (87/1454), and cardiac death or MI in 13.1% (190/1454). Among Whites versus non‐Whites, NIT occurred in 33.8% (284/839) versus 28.1% (173/615; odds ratio [OR] 0.76, 95% confidence interval [CI] 0.61–0.96) and catheterization in 15.9% (133/839) versus 10.4% (64/615; OR 0.62, 95% CI 0.45–0.84). After covariates were adjusted for, non‐White race remained associated with decreased 30‐day NIT (adjusted OR [aOR] 0.71, 95% CI 0.56–0.90) and cardiac catheterization (aOR 0.62, 95% CI 0.43–0.88). Revascularization occurred in 6.9% (58/839) of Whites versus 4.7% (29/615) of non‐Whites (OR 0.67, 95% CI 0.42–1.04). Cardiac death or MI at 30 days occurred in 14.2% of Whites (119/839) versus 11.5% (71/615) of non‐Whites (OR 0.79 95% CI 0.57–1.08). After adjustment there was still no association between race and 30‐day revascularization (aOR 0.74, 95% CI 0.45–1.20) or cardiac death or MI (aOR 0.74, 95% CI 0.50–1.09).ConclusionsIn this U.S. cohort, non‐White patients were less likely to receive NIT and cardiac catheterization compared to Whites but had similar rates of revascularization and cardiac death or MI.