Bangladeshi patients present with non-classic features of acute myocardial infarction and are treated less aggressively in east London, UK.
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.
Barakat
K
K
Departments of Cardiology, Barts and the London NHS Trust, London, UK. k.barakat@qmul.ac.uk
Wells
Z
Z
Ramdhany
S
S
Mills
P G
PG
Timmis
A D
AD
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