Abstract 225: Hispanics And Chest Pain: An Opportunity To Address Healthcare Disparities In A Residency Training Program

Abstract

Background: Racial and ethnic healthcare disparities contribute to significant morbidity, mortality, and healthcare costs in cardiovascular disease. As one of the primary reasons for emergency department (ED) presentation, rapid assessment of patients with chest pain is necessary to guide further intervention and disposition. However, even with continued efforts to achieve health equity and eliminate disparities, Hispanics continue to face significant barriers to healthcare. Our goal was to assess the characteristics, and disposition, of Hispanic patients presenting to the ED with chest pain to identify potential targets for intervention to improve healthcare delivery. Methods: Data was obtained from the electronic medical record warehouse of a large, safety-net, academic hospital from January to December 2020. Patients who presented to the emergency department with a chief complaint of “chest pain” were identified and medical records were reviewed. Bivariate analyses were performed to identify the relationship between Hispanic ethnicity and ED disposition. Results: Hispanic patients who presented with chest pain represented only 4.78% (530 of 11095). Hispanics were of younger age (43.4 vs 48.5) and had lower BP (128.8/77.8 vs 134.5/81.5), but were 2.93 times more likely to be uninsured (2.44-3.51, 95% CI, p<0.05). Hispanic females were 1.58 more likely to present with chest pain (1.32-1.88, 95% CI, p<0.05). Although Hispanics were admitted more often (17.74 vs 16.79%), overall disposition from the ED (admit to inpatient, observation, discharge) was 1.39 times longer for this ethnic group (99.0 vs 71.0 min, p<0.05). Disposition for admitted Hispanics took 1.98 times longer, (86.0 vs 43.5 min, p<0.05). Discussion: Our study suggests that Hispanics with chest pain may experience delays in triage and disposition from the ED. Contributing factors may be due to higher prevalence of undocumented status, lack of insurance, language barriers, and a lack of Hispanic providers who promote healthcare equity. Our next steps are to begin a focused educational program for residents to demonstrate that physician driven interventions are an effective way to promote the elimination of racial and ethnic healthcare disparities.