MGH Logo The need for urgent care now seems to be dependent on the race an individual belongs to. Experts from the Massachusetts General Hospital (MGH) claim that African-American and Hispanic patients with chest pain were less likely than white patients to require immediate care, despite a lack of significant differences in symptoms. The results were reported after considering factors such as whether patients arrived by ambulance or a day of the week.

According to the guidelines of American College of Cardiology and American Heart Association immediate electrocardiogram (ECG) examination should be conducted for any patient with chest pain. Previous investigations have displayed racial, ethnic and gender-based differences in patients with cardiac symptoms. These analyses have claimed that such patients can be provided with procedures like cardiac catheterization, angioplasty and coronary artery bypass surgery. In the current study, investigators inspected if initial, emergency-room triage decision which is a quick assessment to determine patients requiring immediate care than those who can wait.

Lenny Lopez, MD, MPH, of the Mongan Institute for Health Policy at MGH, the study’s lead author, affirmed, “In this first nationally representative sample of emergency room patients, we found persistant racial, gender and insurance-coverage based differences in triage categorization and cardiac testing. Emergency room triage is the critical step that determines the whole cascade of clinical decisons and testing that happens next, so if patients are misclassfied on arrival, they won’t receive the care they need when they need it.”

In the course of the study, scientists examined data accumulated by the National Hospital Ambulatory Health Care Survey of Emergency Departments (NHAMCS-ED). The information dated 1997-2006 and comprised age, gender, race/ethnicity and insurance status of patients coming to the surveyed hospital departments (EDs) with chest pain. Four triage categories are employed by the NHAMCS-ED. These groups may include emergent for patients who should be seen immediately, urgent for those who can wait 15 to 60 minutes, semi-urgent for patients who can wait one to two hours, and non-urgent for those who can wait two hours or longer.

Lopez quoted, “These differences in ED triage may be important drivers of disparities in testing, procedures and eventual outcomes. If you are misclassified at this first step, you’re less likely to get the ECG because your condition is not considered urgent. In the long term, you may have an even more severe heart attack that could have been prevented if intervention had occurred earlier. This is not an area of medicine where there is a lack of clarity about what we are supposed to do, so quality improvement strategies need to focus on 100 percent guideline-driven triage management for every single patient.”

During the present investigation, authors segregated patients into two categories that were classified as emergent, and those in the last two as non-emergent. The analysis encompassed a total sample of 235,000 ED visits over the 10-year period. From the patients approximately 22,000 reported chest pain or related symptoms namely tightness or burning in the chest area. It was observed that patients provided with an ED diagnosis of possible myocardial infarction (heart attack) had no major variations in initial symptoms between racial or ethnic groups.

A prior study had concluded that women eventually diagnosed with heart attack were less likely to report chest pain as compared to men. But in this study patients with chest pain appeared to have a racial disparity. It was claimed that African American and Hispanic patients are considerably less able to be triaged as emergent white patients. Experts also noted that African American and Hispanic patients and those who were uninsured or covered by Medicaid were less likely to receive basic cardiac testing procedures like ECG, cardiac monitoring or measurement of cardiac enzymes.

The study is published in Academic Emergency Medicine.