Document Detail

Perceptions of chest pain differ by race.
MedLine Citation:
PMID:  12094188     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: African American patients are less likely to receive thrombolytic therapy and coronary revascularization than are white patients. Delay and clinical presentation may be keys to understanding differences in care. OBJECTIVE: To determine how symptom recognition and perception influence clinical presentation as a function of race, we characterized symptoms and care-seeking behavior in African American and white patients seen in the ED with chest pain. METHODS: The prospective study was conducted from April 1999 to September 1999 among patients who were seen in the ED and were admitted or observed in the ED Chest Pain Unit (n = 215). Interviews were conducted within 48 hours with a structured set of questions. RESULTS: Thirty-one percent of white patients and 8.9% of African American patients were admitted with a diagnosis of acute myocardial infarction (P =.001). African American patients were as likely as white patients to report "typical" objective symptoms but were more likely to attribute their symptoms to a gastrointestinal source rather than a cardiac source (P =.05). Of those patients with the final diagnosis of myocardial infarction (n = 45), 61% of African American patients attributed symptoms to a gastrointestinal source and 11% to a cardiac source, versus 26% and 33%, respectively, for white patients. The median prehospital delay for African American patients was 263 minutes (interquartile range, 120 to 756 minutes), similar to the 247 minutes for white patients (interquartile range, 101 to 825 minutes, P =.72), despite African American patients (80%) being more likely than white patients (66%) to perceive their symptoms as severe/life-threatening at onset (P =.05). CONCLUSION: Racial differences in symptom perception exist. Although the proportion of objectively defined typical symptoms were similar, self-attribution was more often noncardiac in African American patients than in white patients. Self-attribution, in addition to objective clinical findings, is likely to influence caregiver diagnostic approaches and therefore therapeutic approaches, and merits further study.
Diane Klingler; Robbya Green-Weir; David Nerenz; Suzanne Havstad; Howard S Rosman; Leonard Cetner; Samir Shah; Frances Wimbush; Steven Borzak
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American heart journal     Volume:  144     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-02     Completed Date:  2002-07-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  51-9     Citation Subset:  AIM; IM    
Henry Ford Heart and Vascular Institute, USA.
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MeSH Terms
African Continental Ancestry Group*
Chest Pain / ethnology*,  etiology,  psychology
European Continental Ancestry Group*
Gastrointestinal Diseases / complications,  psychology
Middle Aged
Myocardial Infarction / complications,  ethnology*,  psychology
Patient Acceptance of Health Care
Prospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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