Bangladeshi patients present with non-classic features of acute myocardial infarction and are treated less aggressively in east London, UK

Abstract

Objective: To analyse differences in the presentation and management of Bangladeshi and white patients with Q wave acute myocardial infarction (AMI). Design: Prospective observational study. Setting: East London teaching hospital. Participants: 263 white and 108 Bangladeshi patients admitted with Q wave AMI. Main outcome measure: Character of presenting symptoms, their interpretation by the patient, and the provision of emergency treatment.Results: There were no significant differences between Bangladeshi and white patients in the time from pain onset to hospital arrival (arrival time 64.5 (117.5) minutes v 63.0 (140.3) minutes, p = 0.63), but once in hospital it took almost twice as long for Bangladeshi as for white patients to receive thrombolysis (median (interquartile range) door to needle time 42.5 (78.0) minutes v 26.0 (47.7) minutes, p = 0.012). Bangladeshis were significantly less likely than whites to complain of central chest pain (odds ratio (OR) 0.11, 95% confidence interval (CI) 0.03 to 0.38; p = 0.0006) or to offer classic descriptions of the character of the pain (OR 0.25, 95% CI 0.09 to 0.74; p = 0.0118). These differences persisted after adjustment for age, sex, and risk factor profile differences including diabetes. Proportions of Bangladeshi and whites interpreting their symptoms as "heart attack" were similar (45.2% v 46.9%; p = 0.99). Conclusions: Bangladeshi patients with AMI often present with atypical symptoms, which may lead to slower triage in the casualty department and delay in essential treatment. This needs recognition by emergency staff if mortality rates in this high risk group are to be reduced.

Presentation of stable angina pectoris among women and South Asian people

“…In addition, the prevalence of typical symptoms is higher among people of South Asian descent than among white people. 3 Despite these findings, it is widely perceived that women, [4][5][6] South Asian people [7][8][9] and other ethnic minorities with suspected ischemia are more likely than white men to report atypical features of pain. 10,11 This has been attributed to vasospastic and microvascular angina in women 12 and to the higher prevalence of diabetes mellitus 13 and socio-economic deprivation 7 among South Asian people.…”

“…Both women 14,15 and South Asian 16,17 patients are less likely than men and white people in general to undergo invasive management of angina. It has been proposed that differences in how these patients describe their symptoms may contribute to inequalities in medical care, 8,18 because the diagnostic validity of symptoms plays an important role in deciding appropriate clinical management. 19 However, it is not known if the distinction between typical and atypical symptoms of chronic stable angina pectoris has similar prognostic value for subsequent coronary events in women and men of white and South Asian ethnic backgrounds.…”

Improving the delivery of coronary care for ethnic minorities

“…4 Therefore, the delay in diagnosis is not caused by a different appreciation of patients from the ethnic minority community of the potential significance of their symptoms. However, an inability to communicate effectively with health care providers is a well recognised and important barrier to health care delivery.…”

“…In a recent issue of Heart, Barakat and colleagues 4 report an interesting observational study comparing the presentation and treatment of Bangladeshi and white patients admitted with acute myocardial infarction (MI) in east London. They found no significant differences between Bangladeshi and white patients in their own interpretation of the symptoms as being potentially MI and in the time from onset of chest pain to arrival in hospital.…”

Quality of Life in a mixed ethnic population after myocardial infarction

“…There are also ethnic differences in healthcare-seeking behaviour and the way doctors manage South Asian people with chest pain [8][9][10]. South Asian people in the UK with myocardial infarction (MI) experience disproportionately greater delays with respect to diagnosis and treatment [11,12], are less likely to use an ambulance [5], they wait longer for specialist referral [13,14] and are less likely to be treated with thrombolysis [15,16], or receive exercise testing [17] or angiography [18,19]. This is in addition to the many general barriers to accessing healthcare that face many South Asian people with heart disease [20,21].…”