Patients with phonetically uncommon surnames had 16.8-min longer FMC-to-STEMI diagnosis and 17.5-min longer FMC-to-balloon times, with no difference in long-term MACE.
Does having a phonetically uncommon surname delay time to diagnosis and worsen outcomes in patients with STEMI?
Implicit bias based on patient surnames can significantly delay STEMI diagnosis and FMC-to-balloon times, though standardized post-diagnosis protocols may prevent disparities in long-term clinical outcomes.
Absolute Event Rate: 0% vs 0%
Background Patients with marginalised characteristics experience delayed ST-elevation myocardial infarction (STEMI) diagnosis despite fast-track protocols. We aimed to determine whether patients with phonetically uncommon surnames in our community experience delays from first medical contact (FMC) to STEMI diagnosis compared with patients with common surnames within an established fast-track network. Methods The Fast-Track Protocol for ST-Elevation Myocardial Infarction prospective registry enrolled consecutive STEMI patients from June 2008 to November 2024. Patient surnames were classified as phonetically common or uncommon using standardised phonetic matching against Canton Fribourg population data. Generalised linear models examined FMC-to-diagnosis time, FMC-to-balloon time and infarct size markers. Cox regression assessed major adverse cardiac and cerebrovascular events (MACE) at 30 days, 1 year and 5 years. Results Among 1208 patients, 284 (23.5%) had phonetically uncommon surnames. Patients with uncommon names experienced prolonged FMC-to-diagnosis time (59.4±87.6 vs 40.6±37.6 min; mean difference +16.8 min; p=0.009) and FMC-to-balloon time (116.8±90.5 vs 97.5±45.7 min; mean difference +17.5 min; p=0.016). Patients with uncommon names were significantly more likely to exceed the 90 min FMC-to-balloon threshold (39.2% vs 48.4%; p=0.010) and the 120 min threshold (16.4% vs 23.5%; p=0.018). Diagnosis-to-balloon time remained unaffected (p>0.80). Peak creatine kinase muscle–brain showed non-significant elevation (mean difference +52.0 U/L; p=0.077). No differences were observed in MACE at 30 days and 5 years between patients with common and uncommon names. Conclusions Patients with phonetically uncommon surnames experienced significant STEMI diagnostic delays within an efficient fast-track network. Protocol-driven care following diagnosis operated equitably, leading to no difference in long-term MACE.
Garín et al. (Mon,) reported a other. Patients with phonetically uncommon surnames had 16.8-min longer FMC-to-STEMI diagnosis and 17.5-min longer FMC-to-balloon times, with no difference in long-term MACE.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: