Heart Attack Diagnosis Tool Misses Some Patients

Ethnicity, race affect accuracy of computerized system, study finds

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WEDNESDAY, May 4, 2005 (HealthDay News) -- Computerized risk assessment tools used by emergency room doctors to diagnose a heart attack may be inaccurate in some ethnic and racial groups, warns a new study comparing heart attack symptoms in American and Asian patients.

"It's notorious that women and elderly patients have markedly different heart attack symptoms from the younger male population. This study shows us that race and ethnicity also play a role in symptoms," Dr. Chadwick D. Miller, an instructor in emergency medicine at Wake Forest University School of Medicine, said in a prepared statement.

Wake Forest was one of nine medical centers in the United States and Singapore that took part in the study of the Acute Coronary Ischemia-Time Insensitive Predictive Instrument (ACI-TIPI), which is designed to assess whether a person is having a heart attack.

ACI-TIPI isn't widely used clinically but it does have elements that form the basis of many other risk assessment tools.

The researchers analyzed data from about 12,000 patients who had symptoms of possible heart attack, such as chest pain and shortness of breath, in order to assess the accuracy of ACI-TIPI in predicting acute coronary syndrome (ACS). Of the nearly 12,000 patients in the study, 1,120 were diagnosed with ACS.

"What we found was that in Singapore, patients were less likely to exhibit the typical symptom of heart attack: chest pain. Age and male gender also had little predictive power in evaluating whether these patients were having a heart attack," Miller said.

He said the findings suggest that doctors need to consider racial and ethnic factors when they use heart attack risk assessment tools. The study results also illustrate the importance of considering ethnic differences when designing new risk assessment tools.

"Given the previously demonstrated differences in ethnic groups, combined with our findings, one must question the utility of population-based cardiac risk assessment. We know that the typical American patient presents with crushing chest pain. But, this approach doesn't take into account the different ethnicities that might present differently," Miller said.

The findings are published in the May issue of Academic Emergency Medicine.

More information

The American Heart Association has more about heart attack.

SOURCE: Wake Forest University Baptist Medical Center, news release, May 1, 2005

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