Acute Coronary Syndrome: The Sad Facts in Black and White

Study finds that black patients who visit the emergency department with ACS have more symptoms and higher symptom severity than white patients.

Health care disparities are a hot topic. Everyone should be able to access care and reap the benefits of medical advances. Researchers have great interest in how health care delivery and receipt differs by race or ethnicity, sex or gender identity, age, disability, socioeconomic status, and geographic location. In many areas of medicine, overall outcomes have improved, but only for certain groups. In general, patients of lower socioeconomic status or of color have less access to care and less promising outcomes than other groups. Researchers from the University of Illinois at Chicago and Salem Health Systems in Salem, Oregon, looked at potential health disparities for patients being seen for probable acute coronary syndrome (ACS) in the emergency department (ED).

Their prospective study, published in the July issue of Heart & Lung: The Journal of Acute and Critical Care, identified disparities between non-Hispanic blacks and non-Hispanic whites (n = 663) presenting to 4 EDs with symptoms that suggested ACS. The researchers tracked clinical presentation, treatment, and patient-reported outcome variables at baseline, 1 month, and 6 months in geographically diverse locations.

Treatment (or care) appeared to be similar for patients regardless of race, and more than 80% of the sample was insured; this is an encouraging finding.

Blacks were disadvantaged on all statistically significant measures compared with whites, however. Blacks with confirmed ACS tended to be younger, have lower income, and have less education. They were particularly disadvantaged in terms of preventable and/or modifiable risk factors, reporting more hypertension, diabetes, and tobacco use. At clinical presentation, black patients reported more symptoms and higher symptom severity, and had longer prehospital delays that exceeded the 3 hours recommended for optimal treatment than white patients.

Blacks who reported palpitations, unusual fatigue, and chest pain were more than 3 times as likely as whites to have ACS confirmed. Blacks with ACS also made more outpatient visits for care and had more symptoms 1 month following discharge.

The authors conclude that when patients present with symptoms suggestive of ACS, significant racial disparities remain in clinical presentation and outcomes for blacks. Black patients’ symptoms were different from white patients’ symptoms, indicating that the classic presentation profile may not apply across races. These patients sorely need patient-centered interventions to improve their prognoses. Prevention remains critical.