Racial differences in management and outcomes of acute myocardial infarction during COVID-19 pandemic.
COVID-19
/ mortality
Coronary Angiography
/ methods
Critical Pathways
/ organization & administration
England
/ epidemiology
Female
Health Services Needs and Demand
Healthcare Disparities
/ standards
Hospitalization
/ statistics & numerical data
Humans
Male
Middle Aged
Non-ST Elevated Myocardial Infarction
/ ethnology
Outcome and Process Assessment, Health Care
Race Factors
SARS-CoV-2
ST Elevation Myocardial Infarction
/ ethnology
acute coronary syndrome
health care
outcome assessment
Journal
Heart (British Cardiac Society)
ISSN: 1468-201X
Titre abrégé: Heart
Pays: England
ID NLM: 9602087
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
25
09
2020
revised:
27
12
2020
accepted:
30
12
2020
pubmed:
10
3
2021
medline:
20
4
2021
entrez:
9
3
2021
Statut:
ppublish
Résumé
There are concerns that healthcare and outcomes of black, Asian and minority ethnic (BAME) communities are disproportionately impacted by the COVID-19 pandemic. We investigated admission rates, treatment and mortality of BAME with acute myocardial infarction (AMI) during COVID-19. Using multisource national healthcare records, patients hospitalised with AMI in England during 1 February-27 May 2020 were included in the COVID-19 group, whereas patients admitted during the same period in the previous three consecutive years were included in a pre-COVID-19 group. Multilevel hierarchical regression analyses were used to quantify the changes in-hospital and 7-day mortality in BAME compared with whites. Of 73 746 patients, higher proportions of BAME patients (16.7% vs 10.1%) were hospitalised with AMI during the COVID-19 period compared with pre-COVID-19. BAME patients admitted during the COVID-19 period were younger, male and likely to present with ST-elevation acute myocardial infarction. COVID-19 BAME group admitted with non-ST-elevation acute myocardial infarction less frequently received coronary angiography (86.1% vs 90.0%, p<0.001) and had a longer median delay to reperfusion (4.1 hours vs 3.7 hours, p<0.001) compared with whites. BAME had higher in-hospital (OR 1.68, 95% CI 1.27 to 2.28) and 7-day mortality (OR 1.81 95% CI 1.31 to 2.19) during COVID-19 compared with pre-COVID-19 period. In this multisource linked cohort study, compared with whites, BAME patients had proportionally higher hospitalisation rates with AMI, less frequently received guidelines indicated care and had higher early mortality during COVID-19 period compared with pre-COVID-19 period. There is a need to develop clinical pathways to achieve equity in the management of these vulnerable populations.
Identifiants
pubmed: 33685933
pii: heartjnl-2020-318356
doi: 10.1136/heartjnl-2020-318356
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
734-740Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.