Emergency & Trauma

June 2, 2022

Sex & race & door-to-ECG time

More than a third of patients presenting at the emergency department with a suspected heart attack have a “delayed” ECG measure of heart function, with Black patients, females and non-English speakers more likely to experience delays.

Patients suspected of having a heart attack receive electrocardiogram testing (ECG), with median door-to-ECG time (D2E) being a common emergency department performance measure. 

A study reported in the Journal of the American Heart Association by Maame Yiadom, MD, MPH, MSCI, Dandan Liu, PhD, and colleagues examines the proportion of ED heart attack patients with D2E greater than 10 minutes (an ED practice standard), looking for operational patterns and patient characteristics associated with slower performance. 

Examining records of 676 heart attack patients evaluated at 10 EDs across the U.S., the study finds 38% had D2E greater than 10 minutes. 

Chances of being in this delayed group were 51% greater for Blacks, 36% greater for females, 7% greater for non-English speakers. Non-white Latinos and people with diabetes also had greater likelihood of a delay.  

Some 62% of ECGs were performed during ED intake, the rest during triage or main ED care.  

To help speed D2E the authors recommended advancing risk stratification methods.

Formerly at Vanderbilt University Medical Center, Yiadom is now associate professor and interim vice-chair of research in the Department of Emergency Medicine at Stanford University. On the study also from VUMC was Wu Gong, MD, MS. The study was supported by the National Institutes of Health (TR000445).