Racial differences in management and outcomes of acute myocardial infarction during COVID19 pandemic

Objective: There are concerns that health care and outcomes of BAME communities are disproportionately impacted by the COVID19 pandemic. We investigated admission rates, treatment and mortality of Black, Asian and Minority Ethnic (BAME) with acute myocardial infarction (AMI) during COVID19. Methods: Using multisource national healthcare records, patients hospitalised with AMI in England during 1st February- 27th May 2020 were included in the COVID19 group, whereas patients admitted during the same period in the previous three consecutive years were included in a pre-COVID19 group. Multilevel hierarchical regression analyses were used to quantify the changes in-hospital and 7-day mortality in BAME compared to whites. Results: Of 73,746 patients, higher proportions of BAME patients (16.7% vs 10.1%) were hospitalised with AMI during the COVID19 period compared to pre-COVID19. BAME patients admitted during the COVID19 period were younger, male and likely to present with STEMI. COVID19 BAME group admitted with NSTEMI less frequently received coronary angiography (86.1% vs 90.0%, p<0.001) and had a longer median delay to reperfusion (4.1h vs 3.7h, p<0.001) compared with whites. BAME had higher in-hospital (OR 1.68 95%CI 1.27-2.28) and 7-day mortality (OR 1.81 95%CI 1.31-2.19) during COVID19 compared to pre COVID19 period. Conclusion: In this multisource linked cohort study, compared to whites BAME patients had proportionally higher hospitalisation rates with AMI, less frequently received guidelines indicated care and had higher early mortality during COVID19 period compared to pre COVID19 period. There is a need to develop clinical pathways to achieve equity in the management of these vulnerable populations.