Racial differences in management and outcomes of acute myocardial infarction during COVID-19 pandemic
Racial differences in management and outcomes of acute myocardial infarction during COVID-19 pandemic
Objective There are concerns that healthcare and outcomes of black, Asian and minority ethnic (BAME) communities are disproportionately impacted by the COVID-19 pandemic. We investigated admission rates, treatment and mortality of BAME with acute myocardial infarction (AMI) during COVID-19. Methods Using multisource national healthcare records, patients hospitalised with AMI in England during 1 February-27 May 2020 were included in the COVID-19 group, whereas patients admitted during the same period in the previous three consecutive years were included in a pre-COVID-19 group. Multilevel hierarchical regression analyses were used to quantify the changes in-hospital and 7-day mortality in BAME compared with whites. Results Of 73 746 patients, higher proportions of BAME patients(16.7% vs 10.1%) were hospitalised with AMI during the COVID-19 period compared with pre-COVID-19. BAME patients admitted during the COVID-19 period were younger, male and likely to present with ST-elevation acute myocardial infarction. COVID-19 BAME group admitted with non-ST-elevation acute myocardial infarction less frequently received coronary angiography (86.1% vs 90.0%, p<0.001) and had a longer median delay to reperfusion (4.1 hours vs 3.7 hours, p<0.001) compared with whites. BAME had higher in-hospital (OR 1.68, 95% CI 1.27 to 2.28) and 7-day mortality (OR 1.81 95% CI 1.31to 2.19) during COVID-19 compared with pre-COVID-19 period. Conclusion In this multisource linked cohort study, compared with whites, BAME patients had proportionally higher hospitalisation rates with AMI, less frequently received guidelines indicated care and had higher early mortality during COVID-19 period compared with pre-COVID-19 period. There is a need to develop clinical pathways to achieve equity in the management of these vulnerable populations.
acute coronary syndrome, health care, outcome assessment
734-740
Rashid, Muhammad
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Timmis, Adam
afa86b24-5997-4e05-a891-ccaa20c90f20
Kinnaird, Tim
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Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Zaman, Azfar
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Shoaib, Ahmad
87d9fdcb-a5ce-4379-8280-3115040dc364
Mohamed, Mohamed O
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De Belder, Mark A
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Deanfield, John
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Martin, Glen Philip
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Wu, Jianhua
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Gale, Chris P
96b5706c-fd86-4b41-9568-3d917ef2c805
Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
1 May 2021
Rashid, Muhammad
f974c0d2-bd55-4d93-940e-1cce3dd0fd59
Timmis, Adam
afa86b24-5997-4e05-a891-ccaa20c90f20
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Zaman, Azfar
1eb39d94-fdb9-466b-ab6c-7613255baf80
Shoaib, Ahmad
87d9fdcb-a5ce-4379-8280-3115040dc364
Mohamed, Mohamed O
c9566561-5ab5-4d7b-b05d-079ebde7a279
De Belder, Mark A
3d0eff51-f1d1-41a7-aac1-e193db082360
Deanfield, John
3ffa04cf-a239-4dd7-8d77-dfc9cfe716fd
Martin, Glen Philip
19b77d4e-b134-477f-a9d5-aaa24385e855
Wu, Jianhua
d1e83015-b7d2-4404-847e-c6f73e281759
Gale, Chris P
96b5706c-fd86-4b41-9568-3d917ef2c805
Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Rashid, Muhammad, Timmis, Adam, Kinnaird, Tim, Curzen, Nick, Zaman, Azfar, Shoaib, Ahmad, Mohamed, Mohamed O, De Belder, Mark A, Deanfield, John, Martin, Glen Philip, Wu, Jianhua, Gale, Chris P and Mamas, Mamas
(2021)
Racial differences in management and outcomes of acute myocardial infarction during COVID-19 pandemic.
Heart, 107 (9), .
(doi:10.1136/heartjnl-2020-318356).
Abstract
Objective There are concerns that healthcare and outcomes of black, Asian and minority ethnic (BAME) communities are disproportionately impacted by the COVID-19 pandemic. We investigated admission rates, treatment and mortality of BAME with acute myocardial infarction (AMI) during COVID-19. Methods Using multisource national healthcare records, patients hospitalised with AMI in England during 1 February-27 May 2020 were included in the COVID-19 group, whereas patients admitted during the same period in the previous three consecutive years were included in a pre-COVID-19 group. Multilevel hierarchical regression analyses were used to quantify the changes in-hospital and 7-day mortality in BAME compared with whites. Results Of 73 746 patients, higher proportions of BAME patients(16.7% vs 10.1%) were hospitalised with AMI during the COVID-19 period compared with pre-COVID-19. BAME patients admitted during the COVID-19 period were younger, male and likely to present with ST-elevation acute myocardial infarction. COVID-19 BAME group admitted with non-ST-elevation acute myocardial infarction less frequently received coronary angiography (86.1% vs 90.0%, p<0.001) and had a longer median delay to reperfusion (4.1 hours vs 3.7 hours, p<0.001) compared with whites. BAME had higher in-hospital (OR 1.68, 95% CI 1.27 to 2.28) and 7-day mortality (OR 1.81 95% CI 1.31to 2.19) during COVID-19 compared with pre-COVID-19 period. Conclusion In this multisource linked cohort study, compared with whites, BAME patients had proportionally higher hospitalisation rates with AMI, less frequently received guidelines indicated care and had higher early mortality during COVID-19 period compared with pre-COVID-19 period. There is a need to develop clinical pathways to achieve equity in the management of these vulnerable populations.
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Accepted/In Press date: 30 December 2020
e-pub ahead of print date: 8 March 2021
Published date: 1 May 2021
Additional Information:
Funding Information:
Funding JW and CPG are funded by the University of Leeds. MM funded by the University of Keele. MR funded by the National Institute of Health Research. The Myocardial Ischaemia National Audit Project is commissioned by the Health Quality Improvement Partnership as part of the National Clinical Audit and Patient Outcomes Programme.
Publisher Copyright:
© 2021 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Keywords:
acute coronary syndrome, health care, outcome assessment
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Local EPrints ID: 511284
URI: http://eprints.soton.ac.uk/id/eprint/511284
ISSN: 1355-6037
PURE UUID: fc90eff4-bf1e-4d4b-932f-9257e4f95245
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Date deposited: 11 May 2026 16:44
Last modified: 12 May 2026 01:42
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Contributors
Author:
Muhammad Rashid
Author:
Adam Timmis
Author:
Tim Kinnaird
Author:
Azfar Zaman
Author:
Ahmad Shoaib
Author:
Mohamed O Mohamed
Author:
Mark A De Belder
Author:
John Deanfield
Author:
Glen Philip Martin
Author:
Jianhua Wu
Author:
Chris P Gale
Author:
Mamas Mamas
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