Ethnic Differences in Acute Coronary Syndromes Care in Emergency Departments.

NCT03463603 | Completed

• 1 other identifier: H13-00617
• Study Type: observational
• Target: 448
• Locations: 1 country
• Sites: 3

Brief Summary

When doctors and nurses use accepted guidelines for quickly treating patients who come to the emergency department (ED) with a possible heart attack, patients do better. Research shows that there are racial-identity- and ethnicity-based differences in the symptoms these patients have, when and why they seek care, the treatments they receive, and how well they fare afterwards. There is also Canadian evidence that there may be racial-identity-based disparities in the care some patients receive, and it has been suggested that health professionals may unconsciously treat patients of different racial identities differently. But it is not known if there is racial-identity variation in the care given to Canadian patients with heart attack symptoms in the critical first hours after coming to an ED, or in their experiences of this care. The investigators collected information from the health records of patients who come to EDs with symptoms of heart attack. The investigators recorded events and times such as what provisional diagnosis was assigned to the patient, how often they received pain medication, how long until certain tests were performed and what treatments were offered. The investigators also collected information about things that might affect delivery of care, e.g., the number of doctors and nurses who were on duty. Participants also completed a short questionnaire about their reasons for coming to the hospital, how long they waited before coming and why, and what their experience in the ED was like. The investigators reviewed this information to see if there are racial-identity-based differences in the care received by patients with heart attack symptoms. The findings could identify important disparities, which could in turn inform future projects to correct these disparities, for example, education of health professionals about ethnic differences in ideas of health and illness.

Conditions

Acute Coronary Syndrome; Racial Bias

Keywords

ischemic heart disease; acute coronary syndrome; racial bias

Outcome Measures

Primary Outcomes (1)

• Door to ECG

  time from Emergency triage to first ECG acquisition

  from hour and minute of admission until the hour and minute of first documented ECG, up to 48 hours

Secondary Outcomes (4)

• Number of assessments by health professionals

  from hour and minute of admission until the hour and minute of transfer to inpatient unit or discharge from Emergency Department, whichever comes first, up to 48 hours

• Rate of being offered and consenting to coronary angiogram

  from date of admission until the date of hospital discharge, up to 100 weeks

• Rate of being offered and consenting to any revascularization procedure

  from date of admission until the date of hospital discharge, up to 24 weeks

• ethnic differences in treatment-seeking delay

  from hour and minute of first documented symptoms until the hour and minute of first documented help-seeking, up to 168 hours

Study Arms (3)

Asian racial identity

Those who self-report "Asian" or related terms as their racial identity.

South Asian racial identity

Those who self-report "South Asian" or related terms as their racial identity.

Other racial identity

All others, who self-report neither "Asian", "South Asian" or their related terms as their racial identity.

Eligibility Criteria

• Age: 20 Years+
• Sex: all
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients presenting to Emergency Departments with symptoms suggestive of an acute coronary syndrome.

You may qualify if:

• years of age or older
• presented to the ED and are either referred for immediate cardiology consultation or managed according to a standardized protocol for continued observation and referral for follow-up (whether ultimately admitted or not);
• hemodynamically stable and free of ischemic discomfort for at least one hour
• spoke English, Mandarin, Cantonese, Punjabi
• able to provide informed consent.

You may not qualify if:

• being cared for by any of the Emergency physicians (3) who were co-investigators

Sponsors & Collaborators

• University of British Columbia: lead
• Canadian Institutes of Health Research (CIHR): collaborator
• Michael Smith Foundation for Health Research: collaborator
• Heart and Stroke Foundation of Canada: collaborator

Study Sites (3)

Richmond Hospital

Richmond, British Columbia, V6X 1A2, Canada

Location

Surrey Memorial Hospital

Surrey, British Columbia, V3V 1Z2, Canada

Location

St. Paul's Hospital

Vancouver, British Columbia, V6Z1Y6, Canada

Location

Related Publications (2)

• Iacoe E, Ratner PA, Wong ST, Mackay MH. A cross-sectional study of ethnicity-based differences in treatment seeking for symptoms of acute coronary syndrome. Eur J Cardiovasc Nurs. 2018 Apr;17(4):297-304. doi: 10.1177/1474515117741893. Epub 2017 Nov 15.

  PMID: 29140107 RESULT

• Mackay, M.H., Ratner, P.A., Scheuermeyer, F.X., Veenstra, G., Ramanathan, K.R., O'Sullivan, M.E., Grubisic, M., Murray, C., Humphries, K.H. (2017). Is racism a factor in emergency department care of patients with suspected acute coronary syndrome? Canadian Journal of Cardiology, 33 (10), s125-126.

  RESULT

MeSH Terms

Conditions

Acute Coronary Syndrome; Racism; Myocardial Ischemia

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Prejudice; Social Behavior; Behavior; Social Discrimination

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Clinical Associate Professor

Study Record Dates

• First Submitted: February 5, 2018
• First Posted: March 13, 2018
• Study Start: October 7, 2013
• Primary Completion: January 11, 2017
• Study Completion: April 12, 2017
• Last Updated: March 14, 2018

Record last verified: 2018-03

Locations

CA (3)