Chest pain: EKG less likely for black, publicly insured, or uninsured patients

  • Am J Emerg Med

  • de Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • In the emergency department (ED), black patients with chest pain are less likely than white patients to undergo electrocardiogram (EKG).
  • Patients with public or no insurance are less likely than privately insured to receive standard chest-pain care.

Why this matters

  • Previous studies documenting disparities in triage, testing of chest-pain patients are older and did not adjust for clinical confounders.

Key results

  • Compared with white patients, black patients were less likely to receive EKG: aOR, 0.82 (95% CI, 0.69-0.99).
  • Compared with privately insured:
    • Medicare recipients were less likely to be triaged emergently or receive EKG or cardiac enzymes.
    • Medicaid recipients were less likely to be triaged emergently. 
    • Uninsured were less likely to receive EKG.
  • Above adjusted for age, sex, region, payment, comorbidities, year.
  • Similar but attenuated results after additional adjustment for vital signs, pain severity (n=8189).

Study design

  • Analysis of ED data in annual National Hospital Ambulatory Health Care Surveys, 2009-2015 (n=10,441; representing 51.4 million US patients).
  • Authors assessed records of adults presenting with chest pain and/or similar complaints of potential cardiac origin.
  • Outcomes: triage acuity, evaluation with EKG, and cardiac enzymes.
  • Funding: None.

Limitations

  • Retrospective, cross-sectional, so no causal information.
  • Data on, e.g., pain descriptors unavailable.