Differences in delivery of prehospital ambulance care comparing non-white versus white patients with suspected cardiac chest pain: cross-sectional study

IntroductionQuality implies equitable care irrespective of ethnicity. There have been few previous studies investigating quality of prehospital cardiac care by ethnicity. We aimed to investigate whether prehospital care for suspected cardiac pain varied by ethnicity.Methods We conducted a cross-sectional analysis of retrospective electronic clinical data for patients with chest pain over one year (August 2011 to July 2012) extracted from a single regional ambulance service. This included patient demographic data (ethnicity, age, sex, deprivation), clinical measurements (blood pressure, respiratory rate, pain assessment, temperature, blood glucose, oxygen saturation), drugs (aspirin, nitroglycerin, Entonox, morphine) and outcomes such as transportation to hospital or referral to primary care. We used multivariate regression to investigate differences in care by ethnicity comparing non-white with white patients. ResultsThere were 7046 patients with suspected cardiac chest pain, with 4825 who had ethnicity recorded including 4661 (96.6%) white, 164 (3.4%) non-white (2221 patients had missing data for ethnicity). Non-white patients were similar in sex (p=0.63) and socioeconomic group (p=0.07) but significantly younger in age (p<0.001) than white patients. After correcting for age, sex, socioeconomic status and whether transported to hospital, non-white patients were similar to white patients in recording of blood pressure, pain score or electrocardiogram but significantly more likely to have temperature (77.4 vs.69.8%), blood glucose (78.7 vs. 69.4%), and oxygen saturation (85.4 vs. 80.7%) recorded. There were no differences in aspirin, nitroglycerin, Entonox or morphine treatment but non-white patients were less likely than white patients to be transported to hospital (93.3 vs. 94.4, p=0.02).ConclusionWe found differences in prehospital ambulance care for non-white compared with white patients with cardiac pain that could be due to recording bias, varying clinical condition or provider management. Further analysis should involve larger and more complete datasets to explore ethnic differences in greater detail.