Ethnic disparities in care and outcomes of non-ST-segment elevation myocardial infarction: a nationwide cohort study

Abstract

Aims Little is known about ethnic disparities in care and clinical outcomes of patients admitted with non-ST-segment elevation myocardial infarction (NSTEMI) in national cohorts from universal healthcare systems derived from Europe. Methods and results We identified 280 588 admissions with NSTEMI in the UK Myocardial Infarction National Audit Project (MINAP), 2010–2017, including White patients (n = 258 364) and Black, Asian, and Minority Ethnic (BAME) patients (n = 22 194). BAME patients were younger (66 years vs. 73 years, P < 0.001) and more frequently had hypertension (66% vs. 54%, P < 0.001), hypercholesterolaemia (49% vs. 34%, P < 0.001), and diabetes (48% vs. 24%, P < 0.001). BAME patients more frequently received invasive coronary angiography (80% vs. 68%, P < 0.001), percutaneous coronary intervention (PCI) (52% vs. 43%, P < 0.001), and coronary artery bypass graft surgery (9% vs. 7%, P < 0.001). Following propensity score matching, BAME compared with White patients had similar in-hospital all-cause mortality [odds ratio (OR) 0.91, confidence interval (CI) 0.76–1.06; P = 0.23], major bleeding (OR 0.99, CI 0.75–1.25; P = 0.95), re-infarction (OR 1.15, CI 0.84–1.46; P = 0.34), and major adverse cardiovascular events (MACE) (OR 0.94, CI 0.80–1.07; P = 0.35). Conclusion BAME patients with NSTEMI had higher cardiometabolic risk profiles and were more likely to undergo invasive angiography and revascularization, with similar clinical outcomes as those of their White counterparts. Among the quality indicators assessed, there is no evidence of care disparities among BAME patients presenting with NSTEMI.

Cardiac audit, data and registries: evolution of a national programme

“…Linkage of mortality data from the Office of National Statistics (ONS) had been an early win for MINAP, the largest of the national registries. This opened the door for outcome comparisons in major subgroups including women and ethnic minorities that delivered new, clinically relevant information about the epidemiology of myocardial infarction 37 38. Novel international comparisons followed, allowing UK performance to be benchmarked against other countries 39 40…”

Racial Disparities in Management and Outcomes of Out-of-Hospital Cardiac Arrest Complicating Myocardial Infarction: A National Study From England and Wales

“…The MINAP is a national cardiac audit that collects information around the presenting profile and clinical care of patients hospitalised with diagnosis of AMI in England [13][14][15] . The data collected are utilised for auditing quality of care and public reporting of AMI patients and also provides a resource for academic research 12,14,16 . The database contains information about patient demographics, admission time and method, cardiovascular comorbidities, clinical characteristics, relevant investigations, in-hospital pharmacological and interventional treatments, in-hospital outcomes and discharge treatments 15,17 .…”

“…In contrast, access to United States healthcare systems and the quality of care received depend, to a greater extent, on patient's socioeconomic status and their medical insurance coverage. This means that individuals in the lower socioeconomic strata of society are unable to afford health care expenses despite large governmental expenditure, disproportionately placing the Black population at a disadvantage 11,12 . We used the Myocardial Ischaemia National Audit Project (MINAP), a national registry of AMI hospitalization in England and Wales, to study the impact of patients' ethnicity on the processes of care, and clinical outcomes of patients admitted with AMI complicated by OHCA between 2010 and 2017.…”

Interaction Between Race, Ethnicity, Severe Mental Illness, and Cardiovascular Disease

“…The counterpoint to this is found in UK outcomes data, where no similar disparities have been demonstrated in the general population with acute coronary syndrome, but this has not been explored in patients with SMI. 51 , 52 …”