Date: Wed, 19 Apr 2000 16:32:54 -0700 (PDT)

Doctors miss heart attacks in women, non-whites, study finds

April 19, 2000

Web posted at: 5:24 PM EDT (2124 GMT)

By Gene Emery

BOSTON (Reuters) -- A study of 10,689 Americans who arrived at 10 urban emergency rooms complaining of chest pains found that women and non-whites are less likely to get the treatment they need, according to a New England Journal of Medicine study released Wednesday.

The research, led by Dr. Hector Pope of the New England Medical Center in Boston, also found that emergency doctors failed to diagnose 2.1 percent of all heart attacks and 2.3 percent of the people with unstable angina who should have been admitted to the hospital.

Heart attacks strike 1.1 million Americans each year, half of whom show up at emergency rooms for treatment. That translates into 11,000 missed diagnoses and, often, a malpractice lawsuit, the study concluded.

On the other hand, studies have shown that 70 percent of the people admitted to the hospital with chest pain do not have a problem that warrants immediate hospitalization. Because the price tag for such unnecessary hospitalizations is over $5 billion a year, doctors and hospitals are under pressure from insurance companies to screen out false alarms.

The researchers found doctors were four times more likely to miss a heart attack in a non-white patient than in a white patient.

"In this study, 5.8 percent of the black patients with acute myocardial infarction were not hospitalized, as compared with 1.2 percent of the white patients" with a heart attack, Pope and his colleagues concluded.

"Blacks have more risk factors" for heart disease than whites, "but this fact did not appear to have a strong influence on the diagnostic impressions of the physicians," they said. One reason may be that blacks suffering from a heart attack tend to be 8 to 10 years younger than a white patient, and they tend to be women. Among whites, women at a given age are less likely to suffer a heart attack than men. Those factors, they said, "may partially explain why physicians might be less inclined to suspect" the problem in black patients.

The researchers also discovered that "women under the age of 55 years were at highest risk for not being hospitalized."

The problem usually wasn't incompetence. A heart specialist who later looked at the electrocardiograms of 38 patients who were sent home only found evidence of a serious problem in five.

The Pope study, which involved urban emergency rooms in Massachusetts, Virginia, Wisconsin, Rhode Island, Ohio and North Carolina, attempted to see how many heart attack patients were being missed in 1993, using data from another study.

Copyright 2000 Reuters. All rights reserved.

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