Disparities in Cardiac Care Seen in ED

In a study published in Academic Emergency Medicine by Pezzin et al (1) recently it was reported that disparities exist in cardiac care in ED based on race, gender and insurance differences.

The study showed that race, gender, and insurance differences affected the likelihood of a person presenting to the ER with chest pain receiving one of four common noninvasive diagnostic tests: ECG, cardiac monitoring (CM), oxygen saturation measurement using pulse oximetry (O₂sat), and chest radiography (CXR).

A total of 7,068 persons aged 30 years or older presented to an ED with a primary complaint of chest pain during the six-year period, corresponding to more than 32 million such visits nationally. The adjusted probability of ordering a test was highest for non–African American patients for all tests considered. African American men had the lowest probabilities (74.3% and 62% for electrocardiography and chest radiography, respectively), compared with 81.1% and 70.3%, respectively, among non–African American men. Only 37.5% of African American women received cardiac monitoring, compared with 54.5% of non–African American men. Similarly, African American women were significantly less likely than non–African American men to have their oxygen saturation measured. Patients who were uninsured or self-pay, as well as patients with “other” insurance, also had a lower probability than insured persons of having these tests ordered.

The researchers observe that the study is important in several ways. (2) First the study population is a cross section at the national level, second, the setting is ED as opposed to in-patient or out-patient setting and third, the time trends show that the disparities became worse between 1995 and 2000.

According to the authors:

“This study documents race, gender, and insurance differences in the provision of electrocardiography and chest radiography testing as well as cardiac rhythm and oxygen saturation monitoring in patients presenting with chest pain. These observed differences should catalyze further study into the underlying causes of disparities in cardiac care at an earlier point of patient contact with the health care system”.

1. Pezzin LE, Keyl PM, Green GB. Disparities in the emergency department evaluation of chest pain patients. Acad Emerg Med 2007; 14:149-156.

   2.  See Medscape report.