Prevalence of Atypical Chest Pain Descriptions in a Population from the Southern United States

Summers, Richard L.; Cooper, George J.; Carlton, Frederick B.; Andrews, Michael E.; Kolb, James C

doi:10.1016/s0002-9629(15)40605-6

Cited by 21 publications

(14 citation statements)

References 10 publications

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“…Interestingly, US studies have suggested that regional differences may also exist such that atypical symptoms are more common in the southern USA, where the adjective "sharp" is often used to describe the intensity of pain rather than its character or quality. 14 Whether a similar explanation underlies the increased use of "sharp" as a description in this Bangladeshi cohort is unclear. There is evidence to suggest that there are race and sex based differences in the interpretation of cutaneous pain, 15 implying that similar differences may occur in the interpretation of visceral pain although this is far more difficult to test formally.…”

Section: Discussionmentioning

confidence: 99%

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

Barakat

2003

Heart

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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.

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Section: Discussionmentioning

confidence: 99%

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

Barakat

2003

Heart

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“…Black patients hospitalized with MI in the South reported different symptoms than patients hospitalized in other regions. 26 It is unclear what factors may account for this pattern, although region-specific cultural differences in patients' subjective perceptions of symptoms have been suggested. 26 Racial differences in clinical presentation, including electrocardiographic features, have previously been shown to account for racial differences in the use of reperfusion therapy.…”

Section: Discussionmentioning

confidence: 99%

“…26 It is unclear what factors may account for this pattern, although region-specific cultural differences in patients' subjective perceptions of symptoms have been suggested. 26 Racial differences in clinical presentation, including electrocardiographic features, have previously been shown to account for racial differences in the use of reperfusion therapy. 27 Further, black patients experiencing MI are less likely than white patients to present with "classical" symptoms such as angina or chest discomfort or to attribute their symptoms to cardiac causes.…”

Section: Discussionmentioning

confidence: 99%

Racial differences in reperfusion therapy use in patients hospitalized with myocardial infarction: A regional phenomenon

Rathore

Frederick

Every

et al. 2005

American Heart Journal

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“…One study demonstrated that black patients hospitalized with myocardial infarction in the South reported different symptoms than patients in other regions, suggesting that there may be regionspecific cultural differences in patients' perceptions of symptoms (26). Such racial differences in symptom reporting, if greater in the South, may explain the larger racial differences in some of the treatments assessed.…”

Section: Discussionmentioning

confidence: 99%

Regional variations in racial differences in the treatment of elderly patients hospitalized with acute myocardial infarction

Rathore

Masoudi

Havranek

et al. 2004

The American Journal of Medicine

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PURPOSE-Racial differences in the treatment of patients with myocardial infarction are often presented as nationally consistent patterns of care, despite known regional variations in quality of care. We sought to determine whether racial differences in myocardial infarction treatment vary by U.S. census region. METHODS-We conducted a retrospective analysis of medical record data from 138,938 elderly fee-for-service Medicare beneficiaries hospitalized with myocardial infarction between 1994 and 1996. Patients were evaluated for the use (admission, discharge) of aspirin and beta-blockers, and cardiac procedures (cardiac catheterization, any coronary revascularization) within 60 days of admission.RESULTS-Nationally, black patients had lower crude rates of aspirin and beta-blocker use, cardiac catheterization, and coronary revascularization than did white patients. Racial differences in treatment, however, varied by region. Black patients in the Northeast had rates of aspirin use that were similar to those of white patients on admission (50.6% vs. 49.8%, P = 0.58) and at discharge (77.5% vs. 74.2%, P = 0.07), whereas racial differences were observed in the South (admission: 43.7% vs. 48.8%, P < 0.001; discharge: 69.5% vs. 73.2%, P < 0.001), Midwest (admission: 48.4% vs. 52.3%, P = 0.004), and West (admission: 49.2% vs. 56.2%, P < 0.001; discharge: 70.7% vs. 76.2%, P = 0.02). Racial differences in beta-blocker use were comparable across regions (admission: P = 0.59, discharge: P = 0.89). There were no differences in cardiac catheterization use among black Analyses were conducted under the auspices of Contract Number 500-99-CTO1 ("Utilization and Quality Control Peer Review Organization for the State of Connecticut"), sponsored by the Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services.The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services; the authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare and Medicaid Services, and required no special funding on the part of this contractor. and white patients in the Northeast (38.9% vs. 40.5%, P = 0.24), as opposed to the Midwest (43.3% vs. 48.9%, P < 0.001), South (39.2% vs. 48.5%, P < 0.001), and West (38.3% vs. 48.6%, P < 0.001). Similarly, racial differences in any coronary revascularization use were smallest in the Northeast (22.1% vs. 26.7%, P < 0.001), greater in the Midwest (24.7% vs. 33.5%, P < 0.001), and largest in the South (20.7% vs. 32.0%, P < 0.001) and West (22.9% vs. 33.7%, P < 0.001). Regional variations in racial differences persisted after multivariable adjustment for aspirin on admission (P = 0.09) and any coronary revascularization (P = 0.10). NIH Public AccessCONCLUSION-Racial differences in the use of some therapies for myocardial infarction in patients hospitalized between 19...

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Prevalence of Atypical Chest Pain Descriptions in a Population from the Southern United States

Cited by 21 publications

References 10 publications

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

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

Racial differences in reperfusion therapy use in patients hospitalized with myocardial infarction: A regional phenomenon

Regional variations in racial differences in the treatment of elderly patients hospitalized with acute myocardial infarction

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