Impact of COVID-19 Pandemic on Sex and Racial Disparities in Chest Pain Presentation and Management Through the Emergency Department.

Background: Sex and racial disparities in the presentation and management of chest pain persist, however, the impact of coronavirus disease 2019 (COVID-19) on these disparities have not been studied. We sought to determine whether the COVID-19 pandemic contributed to pre-existing sex and racial disparities in the presentation, management, and outcomes of patients presenting to the emergency department (ED) with chest pain. Methods: We conducted an observational cohort study with retrospective data collection of patients between January 1, 2016, and May 1, 2022. This was a single study conducted at a quaternary academic medical center of all patients who presented to the ED with a complaint of chest pain or chest pain equivalent symptoms. Patient were further segregated into different groups based on sex (male, female), race, ethnicity (Asian, Black, Hispanic, White, and other), and age (18 - 40, 41 - 65, > 65). We compared diagnostic evaluations, treatment decisions, and outcomes during prespecified time points before, during, and after the COVID-19 pandemic. Results: This study included 95,764 chest pain encounters. Total chest pain presentations to the ED fell about 38% during the early pandemic months. Females presented significantly less than males during initial COVID-19 (48% vs. 52%, P < 0.001) and Asian females were least likely to present. There was an increase in the total number of troponins and echocardiograms ordered during peak COVID-19 across both sexes, but females were still less likely to have these tests ordered across all timepoints. The number of coronary angiograms did not increase during peak COVID-19, and females were less likely to undergo coronary angiogram during all timepoints. Finally, females with chest pain were less likely to be diagnosed with acute myocardial infarction (AMI) during all timepoints, while in-hospital deaths were similar between males and females during all timepoints. Conclusions: During COVID-19, females, especially Asian females, were less likely to present to the ED for chest pain. Non-White patients were less likely to present to the ED compared to White patients prior to and during the pandemic. Disparities in management and outcomes of chest pain encounters remained similar to pre-COVID-19, with females receiving less cardiac workup and AMI diagnoses than males, but in-hospital mortality remaining similar between groups and timepoints.

Geographic Variations in Cardiovascular Disease Mortality Among Asian American Subgroups, 2003-2011.

BACKGROUND: There are well-documented geographical differences in cardiovascular disease (CVD) mortality for non-Hispanic whites. However, it remains unknown whether similar geographical variation in CVD mortality exists for Asian American subgroups. This study aims to examine geographical differences in CVD mortality among Asian American subgroups living in the United States and whether they are consistent with geographical differences observed among non-Hispanic whites. METHODS AND RESULTS: Using US death records from 2003 to 2011 (n=3 897 040 CVD deaths), age-adjusted CVD mortality rates per 100 000 population and age-adjusted mortality rate ratios were calculated for the 6 largest Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and compared with non-Hispanic whites. There were consistently lower mortality rates for all Asian American subgroups compared with non-Hispanic whites across divisions for CVD mortality and ischemic heart disease mortality. However, cerebrovascular disease mortality demonstrated substantial geographical differences by Asian American subgroup. There were a number of regional divisions where certain Asian American subgroups (Filipino and Japanese men, Korean and Vietnamese men and women) possessed no mortality advantage compared with non-Hispanic whites. The most striking geographical variation was with Filipino men (age-adjusted mortality rate ratio=1.18; 95% CI, 1.14-1.24) and Japanese men (age-adjusted mortality rate ratio=1.05; 95% CI: 1.00-1.11) in the Pacific division who had significantly higher cerebrovascular mortality than non-Hispanic whites. CONCLUSIONS: There was substantial geographical variation in Asian American subgroup mortality for cerebrovascular disease when compared with non-Hispanic whites. It deserves increased attention to prioritize prevention and treatment in the Pacific division where approximately 80% of Filipinos CVD deaths and 90% of Japanese CVD deaths occur in the United States.

Acupuncture effects on autonomic responses to cold pressor and handgrip exercise in healthy humans.

Acupuncture at P6, Liv 3 and Li 4 attenuates the increase in blood pressure during mental stress in healthy humans. The purpose of this study was to test the hypothesis that acupuncture at these points has a generalized depressor effect seen during other stimuli to the autonomic nervous system. Thirty-eight healthy humans (mean age 33 +/- 13 years) performed handgrip exercise (n = 20) or the cold pressor test (n = 18) before and after acupuncture at P6, Liv 3 and Li4. To control for repeated interventions, subjects underwent an identical protocol on a different day, during which acupuncture was replaced by quiet rest. Blood pressure and heart rate increased similarly during the first and repeat intervention (handgrip or cold pressor test). Acupuncture did not attenuate the increase in blood pressure (delta mean arterial pressure [MAP] 9.3 +/- 1.8 vs 7.3 +/- 3.1 mmHg) or the increase in heart rate (delta heart rate [HR] 6.7 +/- 2.1 vs 6.0 +/- 2.0 bpm) during handgrip exercise. Similarly, acupuncture did not attenuate the increase in blood pressure (delta mean arterial pressure [MAP] 14.8 +/- 5.0 vs 14.8 +/- 4.8 mmHg) or the increase in heart rate (delta heart rate [HR] 5.3 +/- 2.1 vs 8.7 +/- 3.6 bpm) during the cold pressor test. In summary, in normal healthy humans, acupuncture at P6, Liv 3 and Li 4 does not attenuate the blood pressure or heart rate responses during handgrip exercise or the cold pressor test.