Variation in Emergency Medical Service Use for Acute Coronary Syndromes by Ethnicity: An Aotearoa New Zealand Observational Study

Abstract

AIM: This study investigated whether emergency medical services (EMS) use varies by ethnicity among patients hospitalised with acute coronary syndrome (ACS) in Aotearoa New Zealand.

METHODS: All adults (aged ≥18 years) hospitalised with ACS (2019-2021) were identified. EMS use was determined by linkage between national hospitalisation and EMS data. Associations between ethnicity and EMS use for ACS (ST-elevation myocardial infarction [STEMI]; non-STEMI [NSTEMI]; unstable angina [UA]) were assessed.

RESULTS: A total of 19,283 patients with ACS were identified (STEMI 25%, NSTEMI 55%, UA 20%). For STEMI, EMS use was lower in Māori (adjusted odds ratio 0.72, 95% confidence interval [CI] 0.58-0.90), Pacific (0.64, 0.48-0.87), Indian (0.63, 0.43-0.86) and non-Indian Asian (0.52, 0.37-0.74) but not Other patients (0.79, 0.43-1.52), compared with Europeans. Similar findings by ethnicity were found for NSTEMI. Although odds of EMS use were also lower for UA in all ethnic groups compared with Europeans, the magnitude of the reduction was attenuated, and the effect was not statistically significant, apart from for non-Indian Asian patients.

CONCLUSIONS: EMS use prior to admission for ACS was less likely for most ethnic groups compared with Europeans. Heart healthcare access enablers identified in previously published research-including good-quality information, reduced cost and health professional cultural safety-may reduce barriers to EMS use by non-Europeans.