title: Hospital delay in South Asian patients with acute ST-elevation myocardial infarction in the UK.
abstract: BACKGROUND
  South Asians presenting with chest pain in the UK experience disproportionately greater delays with respect to diagnosis and treatment for acute myocardial infarction (AMI). The duration of time between symptom onset and hospital intervention is a critical delay for AMI but there are limited data amongst South Asians. The objectives of this study were to investigate ethnic differences in hospital delay and to look at short-term outcomes in South Asian and White patients presenting with AMI.
  
  
  METHODS
  Between 2004 and 2009, data were collected from 672 AMI patients with ST elevation who subsequently received percutaneous coronary intervention at Sandwell and West Birmingham Hospitals NHS Trust (UK). The hospital delay between the onset of symptoms and arrival time (pre-hospital), and between arrival time and intervention (post-hospital) was calculated.
  
  
  RESULTS
  South Asians were more likely to be in the upper tertile of hospital delay (pre-hospital odds ratio, OR, 1.44, 95% CI 0.93-2.24, p = 0.06; post-hospital OR 1.83, 95% CI 1.05-3.21, p = 0.015), contributing to an overall hospital delay that was longer (median 314, interquartile range, IQR, 195-679 min) than in Whites (median 240, IQR 182-468 min). Women were more likely to be in the upper tertile for pre-hospital delay than men (p = 0.01) and South Asian ethnicity was an independent predictor of post-hospital delay (p = 0.003).
  
  
  CONCLUSIONS
  While the reasons for ethnic differences in AMI-related hospital delay are likely to be multifactorial and complex, there is an urgent need to promote change in both the South Asian patient (delays in arrival) and their treatment (delays in intervention).
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Kendall
authors.forename: Alexandra
authors.initials: A
authors.lastname: Marley
authors.forename: Jeetesh V
authors.initials: JV
authors.lastname: Patel
authors.forename: Jawad M
authors.initials: JM
authors.lastname: Khan
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Blann
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Girish
authors.initials: G
authors.lastname: Dwivedi
mesh_terms: D000328:Adult; D000368:Aged; D001208:Asia / Q000208:ethnology; D044466:Asian People; D016009:Chi-Square Distribution; D004739:England / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D044465:White People