Sex and race disparities in emergency department patients with chest pain and a detectable or mildly elevated troponin
Background: Identifying and eliminating health disparities is a public health priority. The goal of this analysis is to determine whether cardiac testing or outcome disparities exist by race or sex in patients with detectable to mildly elevated serum troponin. Methods: We conducted a secondary analy...
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| Language: | English |
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Elsevier
2025-01-01
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| Series: | American Heart Journal Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602224001381 |
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| author | Lucas M. Boyer Anna C. Snavely Jason P. Stopyra Subha V. Raman Jeffrey M. Caterino Carol L. Clark Alan E. Jones Michael E. Hall Carolyn J. Park Brian C. Hiestand Sujethra Vasu Michael A. Kutcher W. Gregory Hundley Simon A. Mahler Chadwick D. Miller |
| author_facet | Lucas M. Boyer Anna C. Snavely Jason P. Stopyra Subha V. Raman Jeffrey M. Caterino Carol L. Clark Alan E. Jones Michael E. Hall Carolyn J. Park Brian C. Hiestand Sujethra Vasu Michael A. Kutcher W. Gregory Hundley Simon A. Mahler Chadwick D. Miller |
| author_sort | Lucas M. Boyer |
| collection | DOAJ |
| description | Background: Identifying and eliminating health disparities is a public health priority. The goal of this analysis is to determine whether cardiac testing or outcome disparities exist by race or sex in patients with detectable to mildly elevated serum troponin. Methods: We conducted a secondary analysis of the CMR-IMPACT trial that randomized patients with symptoms suggestive of acute coronary syndrome and a detectable or mildly elevated troponin measure from 4 US hospitals to an early invasive angiography or cardiac MRI strategy. The primary endpoint was the composite of all-cause mortality, myocardial infarction, cardiac hospital readmission, and repeat cardiac ED. Secondary outcomes were components of the composite and revascularization. Results: Participants (n = 312, mean age 61 ± 11 years) were 36.2 % non-white and 40.1 % female. The composite outcome occurred in 63.7 % of non-white vs. 49.8 % of white patients (aHR 1.50, 95 % CI 1.08–2.09) and 53.6 % of female vs. 55.6 % of male patients (aHR 0.93, 95 % CI 0.68–1.28). Non-white (aHR 0.57, 95 % CI 0.35–0.92) patients had lower rates of revascularization also less median stenosis (p < 0.001) and stenosis >70 % (p < 0.001) during index cardiac testing. Despite these findings, ACS after discharge was higher among non-white patients (aHR 1.84, 95 % CI 1.11–3.05). Females had lower rates of revascularization (aHR 0.52, 95 % CI 0.33–0.82), but no increase in ACS after discharge (aHR 0.90, 95 % CI 0.55–1.49). Conclusion: Non-white patients had higher rates of ACS following discharge despite lower rates of obstructive CAD following standardization of index cardiac testing. Future disparity works should explore care following the index encounter. |
| format | Article |
| id | doaj-art-bc525cbba16f428d9300fd00575ab7ac |
| institution | OA Journals |
| issn | 2666-6022 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj-art-bc525cbba16f428d9300fd00575ab7ac2025-08-20T02:26:26ZengElsevierAmerican Heart Journal Plus2666-60222025-01-014910049510.1016/j.ahjo.2024.100495Sex and race disparities in emergency department patients with chest pain and a detectable or mildly elevated troponinLucas M. Boyer0Anna C. Snavely1Jason P. Stopyra2Subha V. Raman3Jeffrey M. Caterino4Carol L. Clark5Alan E. Jones6Michael E. Hall7Carolyn J. Park8Brian C. Hiestand9Sujethra Vasu10Michael A. Kutcher11W. Gregory Hundley12Simon A. Mahler13Chadwick D. Miller14Department of Emergency Medicine, University of Cincinnati School of Medicine, Cincinnati, OH, USA; Corresponding author at: Department of Emergency Medicine, University of Cincinnati Medical Center, 3188 Bellevue Ave., Cincinnati, OH 45219, USA.Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USADepartment of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USADivision of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USADepartment of Emergency Medicine, The Ohio State University, Columbus, OH, USADepartment of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USADepartment of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USADepartment of Medicine, University of Mississippi Medical Center, Jackson, MS, USADepartment of Internal Medicine, Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC, USADepartment of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USADepartment of Internal Medicine, Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC, USADepartment of Internal Medicine, Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC, USADepartment of Internal Medicine, Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Internal Medicine, Cardiology, VCU School of Medicine, Richmond, VA, USA; Department of Radiology, VCU School of Medicine, Richmond, VA, USADepartment of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USADepartment of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USABackground: Identifying and eliminating health disparities is a public health priority. The goal of this analysis is to determine whether cardiac testing or outcome disparities exist by race or sex in patients with detectable to mildly elevated serum troponin. Methods: We conducted a secondary analysis of the CMR-IMPACT trial that randomized patients with symptoms suggestive of acute coronary syndrome and a detectable or mildly elevated troponin measure from 4 US hospitals to an early invasive angiography or cardiac MRI strategy. The primary endpoint was the composite of all-cause mortality, myocardial infarction, cardiac hospital readmission, and repeat cardiac ED. Secondary outcomes were components of the composite and revascularization. Results: Participants (n = 312, mean age 61 ± 11 years) were 36.2 % non-white and 40.1 % female. The composite outcome occurred in 63.7 % of non-white vs. 49.8 % of white patients (aHR 1.50, 95 % CI 1.08–2.09) and 53.6 % of female vs. 55.6 % of male patients (aHR 0.93, 95 % CI 0.68–1.28). Non-white (aHR 0.57, 95 % CI 0.35–0.92) patients had lower rates of revascularization also less median stenosis (p < 0.001) and stenosis >70 % (p < 0.001) during index cardiac testing. Despite these findings, ACS after discharge was higher among non-white patients (aHR 1.84, 95 % CI 1.11–3.05). Females had lower rates of revascularization (aHR 0.52, 95 % CI 0.33–0.82), but no increase in ACS after discharge (aHR 0.90, 95 % CI 0.55–1.49). Conclusion: Non-white patients had higher rates of ACS following discharge despite lower rates of obstructive CAD following standardization of index cardiac testing. Future disparity works should explore care following the index encounter.http://www.sciencedirect.com/science/article/pii/S2666602224001381Race disparitiesSex disparitiesRevascularizationACSMACE |
| spellingShingle | Lucas M. Boyer Anna C. Snavely Jason P. Stopyra Subha V. Raman Jeffrey M. Caterino Carol L. Clark Alan E. Jones Michael E. Hall Carolyn J. Park Brian C. Hiestand Sujethra Vasu Michael A. Kutcher W. Gregory Hundley Simon A. Mahler Chadwick D. Miller Sex and race disparities in emergency department patients with chest pain and a detectable or mildly elevated troponin American Heart Journal Plus Race disparities Sex disparities Revascularization ACS MACE |
| title | Sex and race disparities in emergency department patients with chest pain and a detectable or mildly elevated troponin |
| title_full | Sex and race disparities in emergency department patients with chest pain and a detectable or mildly elevated troponin |
| title_fullStr | Sex and race disparities in emergency department patients with chest pain and a detectable or mildly elevated troponin |
| title_full_unstemmed | Sex and race disparities in emergency department patients with chest pain and a detectable or mildly elevated troponin |
| title_short | Sex and race disparities in emergency department patients with chest pain and a detectable or mildly elevated troponin |
| title_sort | sex and race disparities in emergency department patients with chest pain and a detectable or mildly elevated troponin |
| topic | Race disparities Sex disparities Revascularization ACS MACE |
| url | http://www.sciencedirect.com/science/article/pii/S2666602224001381 |
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