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Racial differences in management and outcomes of acute myocardial infarction during COVID-19 pandemic
  1. Muhammad Rashid1,2,
  2. Adam Timmis3,
  3. Tim Kinnaird4,
  4. Nick Curzen5,
  5. Azfar Zaman6,
  6. Ahmad Shoaib1,2,
  7. Mohamed O Mohamed1,
  8. Mark A de Belder7,
  9. John Deanfield8,
  10. Glen Philip Martin9,
  11. Jianhua Wu10,
  12. Chris P Gale10,11,
  13. Mamas Mamas1,2,12
  1. 1 Keele Cardiovascular Research Group, School of Medicine, Keele University, Keele, UK
  2. 2 Department of Cardiology, Royal Stoke University Hospital, Stoke On Trent, UK
  3. 3 NIHR Cardiovascular Biomedical Research Unit, Bart's Heart Centre, London, UK
  4. 4 Department of Cardiology, University Hospital of Wales, Cardiff, UK
  5. 5 Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  6. 6 Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
  7. 7 National Institute for Cardiovascular Outcomes Research, Bart's Health NHS Trust, London, UK
  8. 8 Institute of Cardiovascular Sciences, University College London, London, UK
  9. 9 Division of informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
  10. 10 Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
  11. 11 Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  12. 12 Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Mamas Mamas, Keele Cardiovascular Research Group, School of Medicine, Keele University, Keele, UK; mamasmamas1{at}


Objective There are concerns that healthcare and outcomes of black, Asian and minority ethnic (BAME) communities are disproportionately impacted by the COVID-19 pandemic. We investigated admission rates, treatment and mortality of BAME with acute myocardial infarction (AMI) during COVID-19.

Methods Using multisource national healthcare records, patients hospitalised with AMI in England during 1 February–27 May 2020 were included in the COVID-19 group, whereas patients admitted during the same period in the previous three consecutive years were included in a pre-COVID-19 group. Multilevel hierarchical regression analyses were used to quantify the changes in-hospital and 7-day mortality in BAME compared with whites.

Results Of 73 746 patients, higher proportions of BAME patients (16.7% vs 10.1%) were hospitalised with AMI during the COVID-19 period compared with pre-COVID-19. BAME patients admitted during the COVID-19 period were younger, male and likely to present with ST-elevation acute myocardial infarction. COVID-19 BAME group admitted with non-ST-elevation acute myocardial infarction less frequently received coronary angiography (86.1% vs 90.0%, p<0.001) and had a longer median delay to reperfusion (4.1 hours vs 3.7 hours, p<0.001) compared with whites. BAME had higher in-hospital (OR 1.68, 95% CI 1.27 to 2.28) and 7-day mortality (OR 1.81 95% CI 1.31 to 2.19) during COVID-19 compared with pre-COVID-19 period.

Conclusion In this multisource linked cohort study, compared with whites, BAME patients had proportionally higher hospitalisation rates with AMI, less frequently received guidelines indicated care and had higher early mortality during COVID-19 period compared with pre-COVID-19 period. There is a need to develop clinical pathways to achieve equity in the management of these vulnerable populations.

  • acute coronary syndrome
  • outcome assessment
  • health care

Data availability statement

Data may be obtained from a third party (National Institute of Cardiovascular Outcome Research) and are not publicly available.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data may be obtained from a third party (National Institute of Cardiovascular Outcome Research) and are not publicly available.

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  • Twitter @drrashid05, @NickCurzen, @cpgale3, @MMamas1973

  • Contributors MR and MM were responsible for the study design and concept. MR performed the data cleaning and analysis. MR and MM wrote the first draft of the manuscript, and all authors contributed to the writing of the paper.

  • Funding JW and CPG are funded by the University of Leeds. MM funded by the University of Keele. MR funded by the National Institute of Health Research. The Myocardial Ischaemia National Audit Project is commissioned by the Health Quality Improvement Partnership as part of the National Clinical Audit and Patient Outcomes Programme.

  • Disclaimer The funding organisations for this study had no involvement in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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