May 12, 2025International Journal for Equity in HealthOpen Access

The impact of a disparity-reduction intervention on outcomes of patients with acute coronary syndrome in the emergency department: a clinical trial

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Acute Coronary Syndrome (ACS) (n=264). Intervention: Disparity-reduction intervention (specialized triage and patient navigation program) vs. Standard triage and routine care. Primary outcome: Pain intensity (Numerical Rating Scale) (p=<0.001).

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Key result

A disparity-reduction intervention comprising specialized triage and patient navigation significantly reduced pain intensity and threat perception compared to routine care in vulnerable patients with acute coronary syndrome.

Why the study?

Marginalized patients with acute coronary syndrome often face inequitable care in emergency departments with negative consequences, but the impact of a disparity-reduction intervention on outcomes remained unproven.

Does a disparity-reduction intervention comprising improved triage and patient navigation improve pain management, illness perception, and care timelines in vulnerable patients with acute coronary syndrome?

Population

264 ACS patients in the emergency department

Comparison

Triage improvement plus patient navigation program vs standard triage and routine care

Design

Randomized clinical trial

Authors

SYSajad Yarahmadi MBMehdi Birjandi MGMohammad Gholami

Discussion

Member takes

Overview

Supports implementing ED triage and navigation programs for marginalized ACS patients; extends RCT evidence on equity interventions improving outcomes.

Study Design

Type

RCT (n=264)

Blinding

Double-blind

Randomization

Stratified block randomization

Multicenter

Structured PICO

Population

264 adult patients with confirmed or suspected non-STEMI acute coronary syndrome and at least two socio-demographic vulnerabilities, followed for 1 month post-discharge.

Intervention

Disparity-reduction intervention comprising an improved triage process (welcoming nurse and HEART score risk stratification) and a patient navigation program (supportive education, emergency care coordination, and 1-month follow-up care).

Comparator

Standard triage using the five-level Emergency Severity Index (ESI) system and routine care.

Outcome

Pain intensity, patient opinion of pain management, illness perception, threat perception, and short-term (e.g., door-to-ECG time) and long-term (e.g., 1-month readmission) outcomes.patient reported

Main Result

Absolute Event Rate: 3.5% vs 4.37%

p-value: p=<0.001

Implementing a specialized triage and patient navigation program in the emergency department significantly improves care timelines, pain management, and follow-up adherence for vulnerable patients with acute coronary syndrome.

Limitations

Conducted in a single hospital in Iran, limiting generalizability to other healthcare systems.
Use of self-reported questionnaires may be affected by response bias.
Blinding of the interventionist was not feasible.
Long-term outcomes were measured only up to one month after discharge.
Findings may be influenced by specific cultural norms and healthcare policies in Iran.

Cite This Study

Yarahmadi et al. (2025) conducted an RCT in Acute Coronary Syndrome (ACS) (n=264). Disparity-reduction intervention (specialized triage and patient navigation program) vs. Standard triage and routine care was evaluated on Pain intensity (Numerical Rating Scale) (p=<0.001). A disparity-reduction intervention comprising specialized triage and patient navigation significantly reduced pain intensity and threat perception compared to routine care in vulnerable patients with acute coronary syndrome.

synapsesocial.com/papers/6a8b1fc790fae8fd47e968d9 https://doi.org/10.1186/s12939-025-02496-1

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May 12, 2025International Journal for Equity in HealthOpen Access

The impact of a disparity-reduction intervention on outcomes of patients with acute coronary syndrome in the emergency department: a clinical trial

View Full Paper

Ask AI

Bookmark

Key result

Why the study?

Population

264 ACS patients in the emergency department

Comparison

Triage improvement plus patient navigation program vs standard triage and routine care

Design

Randomized clinical trial

Authors

SYSajad Yarahmadi MBMehdi Birjandi MGMohammad Gholami

Discussion

Member takes

Overview

Supports implementing ED triage and navigation programs for marginalized ACS patients; extends RCT evidence on equity interventions improving outcomes.

Study Design

Type

RCT (n=264)

Blinding

Double-blind

Randomization

Stratified block randomization

Multicenter

Structured PICO

Population

264 adult patients with confirmed or suspected non-STEMI acute coronary syndrome and at least two socio-demographic vulnerabilities, followed for 1 month post-discharge.

Intervention

Comparator

Standard triage using the five-level Emergency Severity Index (ESI) system and routine care.

Outcome

Pain intensity, patient opinion of pain management, illness perception, threat perception, and short-term (e.g., door-to-ECG time) and long-term (e.g., 1-month readmission) outcomes.patient reported

Main Result

Absolute Event Rate: 3.5% vs 4.37%

p-value: p=<0.001

Limitations

Conducted in a single hospital in Iran, limiting generalizability to other healthcare systems.
Use of self-reported questionnaires may be affected by response bias.
Blinding of the interventionist was not feasible.
Long-term outcomes were measured only up to one month after discharge.
Findings may be influenced by specific cultural norms and healthcare policies in Iran.

Cite This Study

synapsesocial.com/papers/6a8b1fc790fae8fd47e968d9 https://doi.org/10.1186/s12939-025-02496-1

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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