Greater clinical surveillance recommended for younger African American women presenting with cardiac events

African American women younger than 50 years old and who were diagnosed with acute myocardial infarction (AMI) had markedly higher rates of hyperlipidemia, hypertension, acute renal failure and type 2 diabetes than their white female counterparts, noted the authors of a recent study of Main Line Health’s four acute care hospitals.

The researchers’ aims were to 1) characterize patients who had been diagnosed with AMI and were discharged from Main Line Health’s emergency departments (EDs) and inpatient care; and 2) to investigate the care pathways female patients, in particular, received in Lankenau’s ED. The study was conducted by investigators in the Main Line Health Center for Population Health Research (CPHR) at Lankenau Institute for Medical Research and Lankenau Heart Institute’s Women’s Heart Initiative program.

Cohort study

The researchers performed a cohort study of all adult patients discharged from Main Line Health’s acute care hospitals between October 2015 and March 2018. They found that about 60 percent of the 3,729 AMI cases were male, and on average, younger than females (72 vs. 78 years). Among those younger than 50 years old, only 50 percent of women and 53 percent of men received orders for a cardiac consult.

The study also found that among women in the younger-aged group, African American women had higher rates of hyperlipidemia (50% vs 40%), hypertension (59% vs 40%), acute renal failure (27% vs 16%), and type 2 diabetes (41% vs 16%) than their white female counterparts.

“Given those results, care providers should consider giving greater surveillance to younger African American women who present with symptoms of a cardiac event,” said Justin Beaupre, EdD, the lead author of the study and a postdoctoral fellow at CPHR. “We found that these female patients are very likely to have comorbidities that require clinical attention.”

Chart review

The study also included a chart review of all adult female patients who came to Lankenau Medical Center’s ED with symptoms suggestive of a cardiac event. The researchers compared the care pathways to age- and race-matched male controls.

“We found that Lankenau’s ED does an exemplary job of ensuring there are no disparities among patients in services provided, such as ECGs, chest X-rays and troponin tests,” said Maribel Hernandez, MD, of the Lankenau Heart Group. “That was a great finding, and we applaud our ED practitioners for their continued diligence in ensuring high-quality cardiac care is delivered to Main Line Health patients.”

The authors presented their results in the abstract “Characteristics of patients diagnosed with acute myocardial infarction within a community health system” at the American Public Health Association’s recent annual meeting held this past month in Philadelphia.

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