Significant racial disparities identified in treatment of heart patients during first wave of Covid-19

Researchers have identified significant disparities between patients from BAME backgrounds compared to white patients in the treatment they received for heart attacks during the first wave of the Covid-19 pandemic, and have called for immediate action to address this inequality.

The study, published today in the journal Heart, found that patients of Black, Asian and Minority Ethnic (BAME) backgrounds were more likely to be admitted to hospital following a heart attack than their white peers; less likely to receive evidence-based care, as indicated by guidelines; and more likely to die early than before the pandemic.

Throughout the pandemic healthcare providers around the world have reported a drop in the number of patients being admitted for heart attacks, as well as a subsequent rise in the number of early deaths and complications.

However, it has also been reported that BAME patients were twice as likely to die from Covid-19 during the first wave, and the researchers including members of Keele University’s Cardiovascular Research Group, wanted to find out if the recognised differences in the health outcomes of BAME patients with heart disease worsened during the first wave pandemic in England.

The researchers used nationwide healthcare records for patients admitted to hospital for a heart attack between February 1st and May 27th 2020, to assess the differences in presentation and treatment between white and BAME patients, before comparing the results with data from the same period over the previous three years (2017-19). In total, 73,746 patients’ data was analysed.

The results indicated that of 62,578 patients admitted to hospital in the pre-Covid-19 era, 56,270 (90%) were white and 6308 (10%) were of BAME origin. This compares with 1863 (nearly 17%) BAME patients in 2020, with the number of daily hospital admissions for heart attack also significantly increased among BAME patients in 2020.

During the Covid-19 period, the monthly proportion of BAME patients admitted to hospital with a heart attack also increased from just over 16% in February 2020 to nearly 18% in May 2020. This monthly rate didn’t change in the pre-Covid-19 era.

Admission rates for heart attacks were 65% higher among BAME than among white patients during the Covid-19 period, with a similar proportional rise observed for each month compared with the same period in the pre-Covid-19 era.

BAME patients were likely to be younger, male, and weigh less (lower BMI) than white patients, but they also tended to have higher cholesterol levels, and were more likely to have heart failure, angina, chronic kidney disease and diabetes requiring insulin treatment.

There were also differences in how patients from different backgrounds were treated, with BAME patients waiting longer than white patients for certain types of invasive procedures and treatment both pre-pandemic and during the Covid-19 period.

Coronary angiography was significantly less likely to be used in BAME patients, who were also less likely to undergo percutaneous coronary intervention (PCI).

After adjusting for potentially influential factors, BAME patients were 68% more likely to die in hospital and 81% more likely to die within seven days of discharge than white patients during the Covid-19 period than they were during the same timeframe in 2017-19.

BAME patients were also 78% more likely to die than white patients after lockdown started (23rd March 2020) than before.

Lead author Professor Mamas Mamas said: “Patients from ethnic minorities tended to present with heart attacks when they were more unwell, which may reflect their worse outcomes. Going forward we need to understand the short-term and long-term effects of Covid-19 among the ethnic minorities. Future efforts should be focused to develop pathways to mitigate the racial differences in the resource utilisation and standardise the care of ethnic minorities.”