Variations in Responding to Chest Pain, Ambulance Utilisation and Clinical Outcomes Among 10 Ethnic Groups: Time, Ethnicity, and Delay (TED) Study III

Abstract

Objective: This study aimed to determine ethnic differences in responding to chest pain and clinical outcomes in Australia. Method: The total of 607 patients from nine ethnic groups and Australian who presented with chest pain to a hospital between 2012 and 2014 were included. Data from the emergency department and medical records were extracted and linked for analyses. Results: The overall median prehospital delay time was 3.7 (1.5, 10.7) hours and the median decision time was 2.0 (0.8, 7.9) hours. Five ethnic groups had significantly longer decision times compared to the Australian group (1.5 hrs); the Sub-Saharan African (4.5 vs 1.5, p = 0.001); the North African and the Middle Eastern (4.1 vs 1.5, p < 0.013); the South-East Asian (3.9 vs 1.5, p = 0.001); the North-East Asian (3.0 vs 1.5, p = 0.006); and the Oceanian groups (2.4 vs 1.5, p = 0.035). Ethnic patients were 60% less likely to respond to chest pain within one hour (odds ratio 0.40, (0.23–0.68), p = 0.001). There was no significant ethnic difference in ambulance utilisation and receiving the Percutaneous Coronary Intervention and angiogram. However, ethnic patients had significantly higher readmission rates at 30-day and 6-month than Australian patients (33.3% vs 9.4%, p = 0.021; and 11.85% vs 5.0%, p = 0.003 respectively). Conclusions: Ethnic differences in responding to chest pain do exist, and ethnicity is an associated factor with a longer delay in seeking care and with a higher readmission rate. To reduce the delays and improve patient outcomes, appropriate health campaigns focusing on ethnic populations and implementing cultural competency into practice are recommended.