Objective To examine whether there are ethnic differences in the health care seeking behaviour and management of patients with chest pain.
Design Prospective cohort of patients attending accident and emergency departments with chest pain
Setting Hospitals in England and Wales from 1st January 2002 to 31st December 2003.
Participants Patients with chest pain.
Main outcome measures Whether patients arrived by ambulance, whether they received thrombolysis and the time it took from symptom onset to arrive in hospital and receive thrombolysis
Results South Asian patients were less likely to arrive by ambulance (age and sex adjusted odds ratio 0.64, 95% CI 0.60 to 0.69, p<0.001) regardless of admission diagnosis. Overall they were more likely to receive thrombolysis (adjusted multivariable odds ratio 1.19, 95% CI 1.10 to 1.30, p<0.001) and the difference was more marked if they had non-specific ECG changes for heart disease rather than definite evidence of a myocardial infarction. There was no evidence of an important clinical delay in South Asians receiving thrombolysis after arrival at hospital.
Conclusions There are ethnic differences in health care seeking behaviour and the way doctors manage South Asians with chest pain. The relative under use of ambulances by South Asians may either reflect cultural differences or geographical proximity to hospitals. Doctors may have a lower threshold for giving thrombolytic therapy to South Asian men with chest pain possibly because they are aware of the increased risk of coronary heart disease in this population.
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