Ethnic minority patients with heart failure are at much higher risk of death than White patients, research has concluded.
According to the study, supported by the charity the British Heart Foundation (BHF) and presented at the British Cardiovascular Society’s conference in Manchester, there are sizeable inequalities in heart failure treatment and outcomes.
The risk of death in ethnic minority heart failure patients was calculated to be 36% higher than that of White patients after an average of 17 months. The study looked at data from more than 16,700 patients.
The research also showed that the disparity was greater if patients also had atrial fibrillation. When the researchers looked at people who also had this condition, and controlled for factors such as age, they calculated that ethnic minority patients were more than twice as likely to die as White patients were during the 17-month follow-up period.
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The analysis of the data from the 12 clinical trials included also showed beta blockers were able to reduce deaths in White patients by 30% but were not able to show the same protective effect in the ethnic minority heart failure patients.
This could be because of too few people with ethnic minority backgrounds being included in the analysis to be able to detect a difference, the researchers argued.
Sebastian Fox and Dr Asgher Champsi, the researchers who led the study as part of Professor Dipak Kotecha’s team at the University of Birmingham, suggested several likely causes for the disparity.
They highlighted evidence from other studies suggesting ethnic minority patients present to doctors later, when the condition is more advanced and harder to treat. They also pointed to variation in the effectiveness and use of treatments across different ethnicities as possible causes.
The researchers underscored that, across the trials analysed, 89% of patients were White, saying that under-representation of ethnic minority patients in trials therefore needs to be addressed as a priority.
Sebastian Fox, final year medical student and co-lead author of the study, said: “It is crucial that steps are taken to close this worrying gap in heart failure treatment and outcomes. The most important thing we can do going forward is include more ethnic minority patients in trials of heart failure treatments. We otherwise risk drawing inappropriate conclusions that treatments are equally effective across different ethnicities.”
Death rates and treatment effectiveness were not the only point of difference between the two groups. Hospitalisation was also much higher in ethnic minority patients. Nearly a third of ethnic minority heart failure patients were hospitalised for cardiovascular problems compared with a quarter of White patients.
If patients had atrial fibrillation too, the difference was even more stark, with around 40% of ethnic minority patients hospitalised versus 30% of White patients.
Dr Sonya Babu-Narayan, BHF associate medical director and consultant cardiologist, said: “This study highlights stark health inequalities in how heart failure outcomes may vary depending on a patient’s ethnicity.
“While this study was observational and cannot tell us about cause and effect, it found that patients with an ethnic minority background were sicker and more likely to die from their heart failure than others.
“If we are to close this gap, it is vital we gain a better understanding of barriers in accessing care that face those from minority ethnicity backgrounds. It is also important that research is representative of those affected by cardiovascular disease, to ensure that tests and treatments can benefit those who need them,” Dr Babu-Narayan added.
AI tool developed for heart attack patients
Separately, researchers have developed a new artificial intelligence (AI) tool that can rapidly rule out heart attacks in people attending A&E, allowing them to be safely sent home.
The research, again funded by the BHF and also presented at the British Cardiovascular Society Conference in Manchester, suggested that, by rapidly ruling out heart attacks in these patients, the new AI tool – called Rapid-RO – could help tens of thousands of people avoid unnecessary hospital stays each year in the UK, so freeing valuable NHS time and resource.
When someone arrives in hospital with a suspected heart attack, blood tests are used to help confirm their diagnosis. The blood tests measure levels of a protein called troponin – which rises when there is damage to the heart muscle.
As this rise may not be reliably seen until hours later, people are often kept in hospital for further troponin tests and ongoing evaluation. Some of these patients will eventually be discharged from hospital without needing hospital treatment after a heart attack is ruled out many hours later.
In the new study, Dario Sesia, a BHF-supported PhD student at Imperial College London, developed a new AI tool to identify patients who are at very low risk, who could potentially therefoere be discharged early following their initial assessment, avoiding hospitalisation.
The team developed, trained and fine-tuned the Rapid-RO AI tool using data from more than 60,000 patients across the UK, before retrospectively testing it on over 35,000 patients across four UK hospitals, over various time periods. They then compared Rapid-RO’s performance to existing methods of ruling out a heart attack based on troponin testing alone.
The team found that, of the 33,727 patients, the AI tool successfully ruled out heart attacks in more than a third (36%) of patients, compared with 27% ruled out by troponin testing alone.
In addition, among these patients, the current approach of troponin testing missed four times as many heart attacks (108 cases) compared to Rapid-RO (27 cases). The researchers found that the AI was effective regardless of ethnicity, sex or whether patients had Covid-19.
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