Work-up for chest pain in the ER differs by race

NEW YORK, Feb 10 (Reuters) African American patients who are seen in the ER for chest pain are less likely than patients from other racial groups to receive standard tests, such as a chest x-ray or an electrocardiogram (ECG), which provides an electrical recording of the heart, new research shows.

The findings also suggest differences in chest pain evaluation based on gender and insurance status.

''A number of studies have looked at racial and gender differences'' in the provision of cardiovascular treatments, lead author Dr Liliana E. Pezzin, from the Medical College of Wisconsin in Milwaukee, told Reuters Health. However, ''few studies have examined how race, gender, and insurance status may affect the evaluation of chest pain in the ER setting.'' To investigate, Pezzin and colleagues took a look back at 7,068 patients seen in a hospital ER for a primary complaint of chest pain between 1995 and 2000.

As mentioned, African American patients were less likely than non-African Americans to be evaluated with ECG, chest x-ray, cardiac monitoring, and pulse oximetry, which measures blood oxygen levels.

African American men had the lowest rates of EXF and chest x-ray usage, 74.3 per cent and 62.0 per cent, respectively. The corresponding rates in non-African American men were 81.1 per cent and 70.3 per cent.

African American women had the lowest rates of cardiac monitoring and pulse oximetry, 37.5 per cent and 41.8 per cent, respectively.

The corresponding rates in non-African American men were 54.5 per cent and 55.8 per cent.

Insurance status also seemed to influence the chest pain work-up.

Uninsured, self-pay, or patients with ''other'' insurance were less likely to receive the tests studied than were insured patients.

''Communications issues could play a role in the differences seen,'' Pezzin said, noting that prior studies have suggested that a physician may not communicate as effectively with someone from a different ethnic group.

However, she added that physician communication issues are probably not the sole explanation since in many ERs the tests studied are often ordered before the doctor even sees the patient.

''This suggests that all people in the ER, particularly those who first see the patient, need to be aware of guidelines for evaluating chest pain.'' Reuters PDM DB0851