Key result
Black STEMI patients presenting to the emergency department were 43% less likely to be admitted to the hospital compared to White STEMI patients.
Why the study?
There are gaps in understanding how patient demographics influence admission risk and length of stay among patients presenting to the emergency department with STEMI.
Observational (n=175,689)
Yes
Effect estimate: OR 0.57 (95% CI 0.43-0.75)
p-value: p=<0.001
Significant racial and socioeconomic disparities exist in the ED management of STEMI, with Black patients being less likely to be admitted and Medicaid patients experiencing longer lengths of stay.
Alerts clinicians to possible STEMI admission inequities; leaves open causal mechanisms and outcome impact.
Background ST-elevation myocardial infarction (STEMI) places a significant burden on the US healthcare system. However, there are gaps in our understanding of how patient demographics influence a STEMI’s risk to be admitted and the length of stay (LOS). Methods We conducted a retrospective analysis of the 2019 Nationwide Emergency Department Sample of patients with a primary diagnosis of STEMI. Multivariate regressions were used to determine factors associated with being admitted and longer length of stay (LOS). Results In 2019, 175,689 STEMI patients presented to the ED and 136,738 (77.8%) patients were admitted. Factors associated with higher risk of being admitted were coronary artery disease (OR:14.34, 95% confidence interval (CI): 12.43-16.54, p<0.001), modified Charlson Comorbidity Index (mCCI) of at least 3 (OR: 9.45, 95% CI: 7.33-12.17, p<0.001), and hyperlipidemia (OR:4.65, 95% CI:4.01-5.39, p<0.001). Black STEMI patients were less likely to be admitted than White STEMI patients (OR: 0.57, 95%CI: 0.43-0.75, p<0.001). Factors associated with a longer LOS include a mCCI of at least 3 (p<0.001), heart failure (p<0.001), and being an elderly patient (p<0.001). Black patients had a longer LOS than White patients (p<0.001). Medicaid beneficiaries were associated with a longer LOS than non-Medicaid beneficiaries (p<0.001). Conclusion Race and insurance status substantially affect a STEMI patient’s outcome in the ED.
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Hum et al. (2022) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=175,689). Black race vs. White race was evaluated on Inpatient admission (OR 0.57, 95% CI 0.43-0.75, p=<0.001). Black STEMI patients presenting to the emergency department were 43% less likely to be admitted to the hospital compared to White STEMI patients.
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