title: Bangladeshi patients present with non-classic features of acute myocardial infarction and are treated less aggressively in east London, UK.
abstract: OBJECTIVE
  To analyse differences in the presentation and management of Bangladeshi and white patients with Q wave acute myocardial infarction (AMI).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  East London teaching hospital.
  
  
  METHODS
  263 white and 108 Bangladeshi patients admitted with Q wave AMI.
  
  
  METHODS
  Character of presenting symptoms, their interpretation by the patient, and the provision of emergency treatment.
  
  
  RESULTS
  There were no significant differences between Bangladeshi and white patients in the time from pain onset to hospital arrival (arrival time 64.5 (117.5) minutes v 63.0 (140.3) minutes, p = 0.63), but once in hospital it took almost twice as long for Bangladeshi as for white patients to receive thrombolysis (median (interquartile range) door to needle time 42.5 (78.0) minutes v 26.0 (47.7) minutes, p = 0.012). Bangladeshis were significantly less likely than whites to complain of central chest pain (odds ratio (OR) 0.11, 95% confidence interval (CI) 0.03 to 0.38; p = 0.0006) or to offer classic descriptions of the character of the pain (OR 0.25, 95% CI 0.09 to 0.74; p = 0.0118). These differences persisted after adjustment for age, sex, and risk factor profile differences including diabetes. Proportions of Bangladeshi and whites interpreting their symptoms as "heart attack" were similar (45.2% v 46.9%; p = 0.99).
  
  
  CONCLUSIONS
  Bangladeshi patients with AMI often present with atypical symptoms, which may lead to slower triage in the casualty department and delay in essential treatment. This needs recognition by emergency staff if mortality rates in this high risk group are to be reduced.
authors.affiliation: Departments of Cardiology, Barts and the London NHS Trust, London, UK. k.barakat@qmul.ac.uk
authors.forename: K
authors.initials: K
authors.lastname: Barakat
authors.forename: Z
authors.initials: Z
authors.lastname: Wells
authors.forename: S
authors.initials: S
authors.lastname: Ramdhany
authors.forename: P G
authors.initials: PG
authors.lastname: Mills
authors.forename: A D
authors.initials: AD
authors.lastname: Timmis
mesh_terms: D017677:Age Distribution; D001459:Bangladesh / Q000208:ethnology; D002637:Chest Pain / Q000208:ethnology / Q000209:etiology / Q000628:therapy; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000628:therapy*; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015912:Thrombolytic Therapy; D013997:Time Factors