Key result
Among 4,358 patients, nonwhite patients had longer times to initial ECG than white patients, and women had longer times than men specifically for noncardiac chest pain.
Why the study?
Does race or gender affect the time to initial ECG in patients presenting to the emergency department with chest pain?
Cohort (n=4,358)
Does race or gender affect the time to initial ECG in patients presenting to the emergency department with chest pain?
Nonwhite patients and women with noncardiac chest pain experience significant delays in receiving an initial ECG in the emergency department, highlighting disparities in emergent cardiac care.
Answers are grounded in this paper and cite their sources.
ECG timing disparities by race and sex in ED chest pain were observed; hypothesis-generating and leaves open whether interventions reduce inequities.
OBJECTIVES: To determine whether race or gender affected time to initial electrocardiogram (ECG) for patients who presented to an emergency department with chest pain. METHODS: This was a prospective cohort study of patients with chest pain. Patients were divided into three groups based on final diagnosis of acute myocardial infarction or unstable angina and all others with noncardiac chest pain. Data were analyzed using ranks in a two-way analysis of covariance adjusted for age. RESULTS: A total of 4,358 patients were studied; 58.6% were women and 41.4% men, and 70.3% were African American, 26.0% white, and 3.6% other. Overall, nonwhite patients had longer times to initial ECG compared with white patients. These effects were consistent regardless of ultimate diagnosis. Overall, women had longer times to initial ECG than men. However, ECG time differed by final diagnosis. There were no differences in time to ECG for women compared with men with acute myocardial infarction or unstable angina, but women received an ECG significantly slower than men for noncardiac chest pain. CONCLUSIONS: The first screening test for acute coronary syndrome, the ECG, took longer to obtain for nonwhite patients, regardless of final diagnosis. This was unfortunately consistent with the literature that shows racial disparities in all aspects of emergent cardiac care. For women, the overall delay in ECG time can be explained by delays for those women with noncardiac chest pain.
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Takakuwa et al. (2006) conducted a cohort in chest pain (n=4,358). Nonwhite race and female gender vs. White race and male gender was evaluated on Time to initial electrocardiogram (ECG). Among 4,358 patients, nonwhite patients had longer times to initial ECG than white patients, and women had longer times than men specifically for noncardiac chest pain.
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