Racial disparities in management and outcomes of out-of-hospital cardiac arrest complicating myocardial infarction; a national study from England and Wales

Abstract

Background Studies of racial disparities in patients admitted with an OHCA in the setting of AMI have shown inconsistent results. Whether these differences in care exist in a universal healthcare system in England is unknown. Methods Patients admitted with a diagnosis of AMI and OHCA between 2010 to 2017 from the Myocardial Ischaemia National Audit Project (MINAP) were studied. All patients were stratified based on ethnicity into Black, Asian, and Minority Ethnic (BAME) group versus White group. We used multivariable logistic regression models to evaluate the predictors of clinical outcomes and treatment strategy. Results From 14,287 patients admitted with AMI complicated by OHCA, BAME patients constituted a minority of patients (1,185(8.3%)) compared to White group (13,102(91.7%)). BAME patients were younger (BAME median age (IQR) 58(50-70) years, White group median age (IQR) 65(55-74) years). Cardiogenic shock (BAME 33%, White group 20.7%, p <0.001) and severe LV impairment (BAME 21%, White group 16.5%, p 0.003) were more frequent among BAME patients. BAME patients were more likely to be seen by a cardiologist (BAME 95.9%, White group 92.5%, p <0.001) and were more likely to receive coronary angiography than the White group (OR 1.5, 95% CI 1.2-1.88). The BAME group had significantly higher in-hospital mortality (OR 1.26, 95%CI 1.04-1.52) and re-infarction (OR 1.52, 95%CI 1.06-2.18) than the White group. Conclusion BAME patients were more likely to be seen by a cardiologist and receive coronary angiography than White group. Despite this, the in-hospital mortality of BAME patients, particularly the Asian population, was significantly higher.