During the first wave of the pandemic in England, there were “significant” racial differences in the presentation and care of heart attack patients. This is the result of a large national study published online in Heart magazine.
Black, Asian, and Ethnic Background (BAME) patients were hospitalized more often than their white counterparts. less likely to receive evidence-based care as indicated in the guidelines; and more likely to die sooner than before the pandemic.
The UK has the highest death toll from COVID-19 and the most ethnically diverse population in Europe. During the first wave of the pandemic, BAME patients were twice as likely to die from COVID-19 as white patients.
Health systems around the world have seen a significant decrease in hospital admissions for heart attacks and a concomitant increase in early death or complications during the COVID-19 pandemic.
The researchers wanted to find out whether the identified differences in health outcomes among BAME patients with heart disease worsened during Wave 1 of the COVID-19 pandemic in England.
They relied on linked medical records from nationwide registries for all patients admitted to heart attack hospitals in England between February 1 and May 27, 2020 to determine if there were differences in presentation and treatment between BAME and white patients gave.
These data were then compared to those of heart attack patients enrolled over the same period over the past three years (2017-19; before COVID-19) to quantify any changes in mortality rates in BAME patients in both hospital and hospital settings within 7 days of discharge.
A total of 73,746 patients were included in the final analysis. Of 62,578 pre-COVID-19 patients hospitalized, 56,270 (90%) were white and 6,308 (10%) were from BAME. This is comparable to 1,863 (almost 17%) BAME patients enrolled in 2020.
The number of daily hospital admissions for heart attacks among BAME patients also increased significantly in 2020.
During the COVID-19 period, the monthly percentage of BAME patients hospitalized with a heart attack rose from just over 16% in February 2020 to almost 18% in May 2020. This monthly rate changed in the pre- COVID period not. 19 era.
Heart attack admission rates were 65% higher for BAME during the COVID-19 period than for white patients, with similar proportional increases observed for each month compared to the same period in the pre-COVID-19 period.
BAME patients were likely younger, male, and weighed less (lower BMI) than white patients. However, they also tended to have higher cholesterol levels and were more likely to have heart failure, angina, chronic kidney disease, and diabetes that required insulin treatment.
Not only were there differences in presentation between BAME and white patients, but there were also differences in the way they were treated.
BAME patients waited longer than white patients for certain types of invasive procedures and treatments during both the pre-COVID-19 and pre-COVID-19 periods.
BAME patients who also had lower rates of PCI (a procedure to restore blood flow) were significantly less likely to have coronary angiography.
Adjusted for potentially influential factors, BAME patients died 68% more often in hospital and 81% more often within 7 days of discharge than white patients during the COVID-19 period than in the same period in 2017-. 19th
BAME patients died 78% more often than white patients after lockdown began (March 23, 2020) than before.
“Immediate countermeasures are needed to raise patient awareness and promote equality for the underserved population during the ongoing COVID-19 pandemic,” the researchers urge.
In a linked editorial, cardiologist Dr. Shrilla Banerjee of the NHS Trust in Surrey and Sussex Healthcare and colleagues suggest that BAME patients tend to be sicker than white patients, which could account for some of the differences in mortality rates.
But there’s no excuse for the differences in care BAME patients have received, they say.
“These observations are now fully recognized as apparent health inequalities and add to the worrying disparities in cardiovascular care affecting BAME populations,” they write.
“There is no biological premise to explain the observed differences. There is no genetic component specific to an ethnic group sufficient to explain the increased adverse outcomes seen in BAME populations in the UK (and in the US) be watched, “they add.
“Unlike the US, the UK has universal health coverage through the National Health Service – a resource that many have expected to reduce or even eliminate health inequalities,” they write. But it doesn’t.
“We need to address barriers to equitable health, including structural racism and social factors, ie education, housing and poverty,” they urge.
But doctors also have to take responsibility, they write. “We need to learn to identify and then eliminate the effects of bias on our patient outcomes … We need to be empowered to draw attention to biased behavior when we see it and be an advocate for all of our patients.”
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Racial Differences in Management and Outcomes of Acute Myocardial Infarction During the COVID-19 Pandemic, Heart (2021). DOI: 10.1136 / heartjnl-2020-318356
Editorial: To be or not to be BAME in the time of COVID-19: Does it matter? Heart (2021). DOI: 10.1136 / heartjnl-2020-318884
Heart provided by the British Medical Journal
Quote: ‘Significant’ racial differences in the care of heart patients during the first wave of pandemics (2021 March 8), accessed March 8, 2021 from https://medicalxpress.com/news/2021-03-significant-racial-disparities-heart -patients. html
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