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Editorial
To be, or not to be BAME, in the time of COVID-19: does it matter?
  1. F Aaysha Cader1,
  2. Clyde W Yancy2,
  3. Shrilla Banerjee3
  1. 1 Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
  2. 2 Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3 Department of Cardiology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
  1. Correspondence to Dr Shrilla Banerjee, Department of Cardiology, Surrey and Sussex Healthcare NHS Trust, Redhill RH1 5RH, UK; shrilla.banerjee{at}nhs.net

https://doi.org/10.1136/heartjnl-2020-318884

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    ”…whether ‘tis nobler in the mind to suffer the slings of outrageous fortune, or take arms against a sea of troubles and by opposing, end them” Hamlet, William Shakespeare

    Coronavirus disease (COVID-19) is currently on a rampant second wave across the globe. The United Kingdom (UK) has the highest death rate in Europe.1 The UK also has the most diverse population in Europe: 14% of the UK population are from black, Asian and minority ethnic (BAME) groups known to have greater consequences of the COVID-19 infection and subsequent worse mortality.2

    In an observational UK study comparing linked acute coronary syndrome data during the COVID-19 infection lockdown (February to May 2020) with the same time period in the preceding 3 years (2017–2019), Rashid and colleagues report troublesome findings. Specifically, higher in-hospital and 7-day mortality rates for acute myocardial infarction in BAME populations during the COVID-19 pandemic than in white populations.3 These disproportionate rates reflect alarming patterns of healthcare delivery to, and outcomes observed in, minority ethnic populations across the globe, and mirror the well-described disparities seen in multiethnic populations of the United States (USA).4 But do these differences qualify as race-based health inequities? Is the UK health service now complicit in the provision of disparate care?

    In their paper, Rashid et al report that BAME patients during COVID-19 lockdown were more likely to present with ST segment elevation myocardial infarction, out of hospital cardiac arrest and cardiogenic shock.3 These important differences in disease acuity might easily account for poorer outcomes and would direct focus towards healthcare-seeking behaviours, rather than disparate care, as targets of intervention. However, delays in the management of acute coronary syndrome presentations, a reduction in invasive angiography in non-ST segment elevation myocardial infarction and less …

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    Footnotes

    • Twitter @ShrillaB

    • Correction notice Since Online First publication, a typographical error in the table has been corrected.

    • Contributors SB wrote the first draft and proposed the initial editorial. FAC and CWY contributed significant additional improvements, revising it critically for important intellectual content.

    • Funding SB and FAC are recipients of the WomenAsOne Mentor Match Award 2021.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this manuscript.

    • Provenance and peer review Commissioned; externally peer reviewed.

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