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Tools for diagnosing heart attack could be inaccurate in some populations

WINSTON-SALEM, N.C. A computerized tool to help emergency room physicians determine whether a patient is having a heart attack may not work as well among some racial and ethnic groups, according to research of almost 12,000 patients at nine medical centers.

"It's notorious that women and elderly patients have markedly different heart attack symptoms from the younger male patient," said Chadwick D. Miller, M.D., from Wake Forest University School of Medicine. "This study shows us that race and ethnicity also play a role in symptoms."

Results from the research, conducted at Wake Forest and eight other medical centers, are reported in the May issue of Academic Emergency Medicine. The researchers studied a computerized risk stratification tool, called the Acute Coronary Ischemia-Time Insensitive Predictive Instrument (ACI-TIPI), which is designed to predict whether a patient is having a heart attack. Although ACI-TIPI itself is not widely used clinically, its elements form the basis of many other risk assessment tools.

There is no single, definitive test to diagnose heart attacks, making it difficult to evaluate chest pain patients. Risk assessment tools have become popular because they allow doctors to make "evidence-based" decisions based on age, gender, health history, questions about chest pain and an electrocardiogram.

"These tools have mostly been tested in an American, mixed-race population of patients. For example, a typical study population may be comprised of 60 percent Caucasian, 30 percent African-American and 10 percent Hispanic patients," said Miller, an instructor in emergency medicine at Wake Forest's School of Medicine, which is part of Wake Forest University Baptist Medical Center. "This design does not detect subtle differences that may exist among the groups."

It has been demonstrated that race and ethnicity influence both the perception of chest pain and the time it takes people to seek treatment.
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Contact: Karen Richardson
krchrdsn@wfubmc.edu
336-716-4453
Wake Forest University Baptist Medical Center
1-May-2005


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