Improving the delivery of coronary care for ethnic minorities.

The UK population is now diverse with nearly 7% of patients from the minority ethnic communities. The incidence and prevalence of coronary heart disease (CHD) is higher in many of these ethnic minority communities compared to their white counterparts. There have been repeated concerns raised about access to appropriate health care for patients from minority groups after CHD has been diagnosed. There are many possible reasons that could affect access and these need to be teased out if improvements are to occur. In a recent issue of Heart, Barakat and colleagues report an interesting observational study comparing the presentation and treatment of Bangladeshi and white patients admitted with acute myocardial infarction (MI) in east London. They found no significant differences between Bangladeshi and white patients in their own interpretation of the symptoms as being potentially MI and in the time from onset of chest pain to arrival in hospital. However, once the patients were in hospital it took almost twice as long on average (42.5 v 26 minutes) for the Bangladeshi patients to receive thrombolysis compared to the white patients. This was despite a greater proportion of the Bangladeshi patients being male, suffering from diabetes mellitus or having had a previous acute MI, which should have led to a greater suspicion of MI. Given the importance of rapid administration of thrombolytic treatment to appropriate patients and the emphasis put on this issue in the National Service Framework for coronary heart disease, the findings raise some concern.