Acute coronary syndrome (ACS) refers to a spectrum of clinical presentations such as a heart attack (myocardial infarction) or unstable angina.
Gender and racial disparities persist in the emergency department (ED) when it comes to the
evaluation of chest pain with the potential for acute coronary syndrome
(ACS); however, not in the way many would expect. That is the main
finding of a study to be published in the February 2017 issue of Academic Emergency Medicine
, a journal of the Society of Academic Emergency Medicine.
‘Physicians' subjective estimation of acute coronary syndrome (ACS) risk was consistently lower for both females and minorities in agreement with calculated objective pretest assessments.’
The study, authored by researchers at the Indiana University School
of Medicine, found evidence that physicians' subjective estimation of
ACS risk was consistently lower for both females and minorities in
agreement with calculated objective pretest assessments. Surprisingly
and contrary to expectations based upon these assessments, there does
not appear to be any significant decrease in the subsequent evaluation
of these perceived lower-risk groups when radiation exposure and costs
are taken into account.
These findings suggest that the ED evaluation of chest pain has
become protocolized to the point that it is immune to the unconscious
and/or systemic bias which have been shown to influence the evaluation
and care of many other conditions in healthcare. Further research and
effort is needed to understand why physicians either tend to
underestimate ACS risk in women and minorities or do not match their
level of subsequent testing to level of risk they assigned.
First author and co-researcher Paul Musey, Jr., assistant
professor at Indiana University School of Medicine, added, "This is
quite surprising because we would have expected physicians to remain
intellectually congruent and offer less testing to the patients they
perceived to be at lower risk of ACS (women and minorities).
"Analysis by gender is vital to research performed by emergency
physicians; in particular, this topic is very germane to practicing
clinicians. It is consistent with the research priorities for examining
the influence of sex and gender on diagnostic choices established
recently by our specialty at the AEM consensus conference on
Gender-Specific Research in Emergency Care and is in line with
expectations of the NIH," said Marna Rayl Greenberg, Director
of EM Research, Lehigh Valley Hospital and co-chair of the 2014 Academic Emergency Medicine
Consensus Conference on Gender-Specific Research in Emergency Care:
Investigate, Understand, and Translate How Gender Affects Patient