Race and Sex Disparities in Heart Attack Care, Survival Not Improving
NEW HAVEN, Conn.
Differences based on race and sex in treatment patterns for hospitalized American heart attack patients have remained unchanged over an eight-year period, despite improvements in quality of heart attack care during this time, Emory and Yale School of Medicine researchers say in the New England Journal of Medicine.
The research showed that use of clinically recommended treatments, including aspirin, beta-blockers and reperfusion therapy (use of a drug to open an artery blocked by a clot) were lower in women and Black patients with a heart attack. Some of these differences were explained by other patient characteristics. Additionally, cardiac catheterization, a diagnostic procedure used to identify blockages in the heart’s circulation commonly performed in patients after a heart attack, was also used less frequently in women and Black patients with a heart attack.
“What concerns me most is that we found persistence of an elevated risk of death among African-American women,” said senior author Dr. Harlan M. Krumholz, professor of medicine and public health at Yale School of Medicine. “This finding, along with evidence of differences in treatment, requires attention and remedy.”
The authors used data from the National Registry of Myocardial Infarction-3 and 4-, a registry of 589,911 patients hospitalized for heart attacks throughout the United States between 1994 and 2002, sponsored by the Genentech Inc. The team evaluated whether race and sex differences in treatment that had been previously reported in heart attack care had changed in subsequent years.
“Lower rates of treatment in patients who are clinically appropriate for treatment are troubling and raise obvious concerns about under-treatment,” said Dr. Viola Vaccarino, associate professor of cardiology and epidemiology at Emory University. “Differences in treatment were not explained by patient age, risk factors or other clinical characteristics that might differ between patients. We simply could not determine the reasons for these differences.”
Saif Rathore, a third-year medical student at Yale and the study’s co-author said, “Continued race and sex disparities suggest that the solution may rely more on health-system related factors. The lack of change suggests that whatever process accounts for these differences is an inherent part of the health care system that isn’t remedied by simply increasing awareness of these differences.”
Rathore said that while some may suggest bias, there may be other explanations, such as beginning to examine differences in how these patients receive care, including possible differences in the quality of hospitals and physicians that treat these populations.
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