Faculty Collaboration Database

Beyond the Beats: Disparities in Prehospital Cardiac Care. J Emerg Med 2026 Jan;80:23-32

Date

11/21/2025

Pubmed ID

41270316

DOI

10.1016/j.jemermed.2025.10.017

Scopus ID

2-s2.0-105022454826 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: While disparities in care between demographic groups (e.g., race/ethnicity, gender, age) have been demonstrated across the spectrum of health care, limited research exists for ST-segment elevation myocardial infarction (STEMI) patients in the prehospital setting.

OBJECTIVE: The purpose of this study was to describe disparities specific to the prehospital care of STEMI using data from a large urban fire-based emergency medical services (EMS) system.

METHODS: Electronic patient care records for all STEMI activations from 02/01/2020 to 09/01/2022 were reviewed. National benchmark variables evaluated included administration of analgesia (either fentanyl or nitroglycerin), nitroglycerin administration, aspirin administration, scene time, transport time, STEMI alert time, and electrocardiogram (ECG) time. Analyses were conducted using logistic and linear regression.

RESULTS: A total of 888 patients were evaluated. The average age was 63.9 years, 575 (63.9%) were male, and 479 (53.9%) were White. Black patients were less likely than White patients to be administered analgesia, as were patients 75 years and older compared to patients 60-74. Female patients were less likely than male patients to receive nitroglycerin or aspirin. Both Black and Hispanic patients were less likely to receive aspirin compared to White patients. Differences in age groups emerged for two-time metrics: Patients 75 years and older had longer scene times and STEMI alert times than patients 60-74. None of the demographic variables were statistically significant predictors of transport time or ECG time.

CONCLUSIONS: This evaluation of comprehensive demographic information from a large fire-based EMS system revealed disparities among STEMI patients in analgesia administration, specifically aspirin and nitroglycerin based on gender and race/ethnicity.

Author List

Wleklinski NP, Nickel LB, Colella MR, McGlynn E, Weston BW

Authors

Riccardo Colella DO, MPH Professor in the Emergency Medicine department at Medical College of Wisconsin
Lauren B. Nickel Research Scientist I in the Emergency Medicine department at Medical College of Wisconsin
Benjamin Weston MPH, MD Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aspirin
Electrocardiography
Emergency Medical Services
Female
Healthcare Disparities
Humans
Male
Middle Aged
Nitroglycerin
Retrospective Studies
ST Elevation Myocardial Infarction