{
  "abstract": "Introduction Myocardial infarction (MI) remains a leading cause of death worldwide. Existing literature demonstrates disparities in the prescriptions of guideline-directed pharmacotherapy on discharge among MI patients of different ethnicities. However, there is little data from within a universal healthcare system. We evaluated whether there were differences in discharge medications across ethnicities in a large National Health Service (NHS) cardiac centre in the UK.Methods This is a single-centre retrospective analysis of patients presenting with ST-elevation MI (STEMI) with an obstructive lesion ≥50% in at least one epicardial artery on coronary angiography at Barts Health NHS Trust in 2017, 2019, and 2022. Discharge medications were extracted from the electronic patient record. They were compared against ethnicity, which was patient-defined, then grouped into Caucasian, South Asian, Black, Other, East Asian, and Unknown. Categorical variables were analysed with χ2 test or Fisher’s exact test, as appropriate, and continuous variables with Kruskal-Wallis test. Multivariate binomial logistic regression was also conducted, adjusting for key patient characteristics, including age, BMI, hypercholesterolaemia, hypertension, statuses of previous MI, percutaneous coronary intervention (PCI) in current admission, and previous PCI.Results 1742 patients were included - Caucasian (n=985, 56.5%), South Asian (n=587, 33.7%), Black (n=105, 6.0%), Other (n=40, 2.3%), East Asian (n=14, 0.8%), and Unknown (n=11, 0.6%). Analysis of patients‘ characteristics revealed several differences between ethnicities. Among the South Asian patients, there was a higher proportion of males (P<0.001) and higher incidences of hypercholesterolaemia (P<0.001), family history (P<0.001), and previous MI (P<0.001). Whereas black patients were more likely to be female (P=0.004) and hypertensive (P=0.04).After adjusting for confounders, multivariate regression showed no significant difference in whether aspirin, P2Y12 inhibitors, statins, angiotensin-II receptor blockers (ARBs), or beta-blockers were prescribed to patients of different ethnicities. The only difference observed was that South Asian patients were less likely to be prescribed an angiotensin-converting enzyme inhibitor (ACEi) (OR 0.703, 95%CI 0.508–0.971, P=0.033) (see figure 1). However, this difference did not persist upon analysis of combined ACEi/ARB, suggesting a higher rate of ACEi-related side effects in South Asian patients but appropriate switching to ARB. Age was an important covariate in the regression model driving differences in the prescription of every category of medication.Conclusion In a universally funded health system with well-protocolised STEMI care, this analysis revealed an equitable approach to prescribing guideline-directed pharmacotherapy in STEMI patients at discharge, across different ethnicities. Future work will be directed at understanding whether differences occur in other sub-types of MI.Abstract 2-057 Figure 1Guideline-directed pharmacotherapy at discharge in South Asian patients. Multivariate logistic regression with caucasian ethnicity being used as the reference population. Adjusted for age, BMI, hypercholesterolaemia, hypertension, statuses of previous MI, PCI in current admission, and previous PCI",
  "authors": [
    {
      "affiliations": [
        "Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK"
      ],
      "name": "Hong Yat Conrad Wong"
    },
    {
      "affiliations": [
        "Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK",
        "Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK"
      ],
      "name": "Andrew J Sullivan"
    },
    {
      "affiliations": [
        "Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK"
      ],
      "name": "Margaret Siu"
    },
    {
      "affiliations": [
        "Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK"
      ],
      "name": "Rebecca Walker"
    },
    {
      "affiliations": [
        "Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK",
        "Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK"
      ],
      "name": "Daniel Jones"
    },
    {
      "affiliations": [
        "Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK",
        "Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK"
      ],
      "name": "Anthony Mathur"
    },
    {
      "affiliations": [
        "Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK"
      ],
      "name": "Amrita Ahluwalia"
    },
    {
      "affiliations": [
        "Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK",
        "Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK"
      ],
      "name": "Krishnaraj S Rathod"
    }
  ],
  "title": "2-057 An analysis of differences in discharge medications following STEMI by ethnicity: a single-centre retrospective study",
  "uid": "630ad745-8ba4-58c0-8888-d63eb3945d6d"
}