The association between patient race, treatment, and outcomes of patients undergoing contemporary percutaneous coronary intervention: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)

Khambatta, Sherezade; Seth, Milan; Rosman, Howard; Share, David; Aronow, Herbert D.; Moscucci, Mauro; LaLonde, Thomas; Dixon, Simon; Gurm, Hitinder S.

doi:10.1016/j.ahj.2013.02.030

Cited by 28 publications

(27 citation statements)

References 24 publications

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“…They will require sophisticated and nuanced approaches that consider people as much as they do systems. Less education/no education beyond high school 6,8 Insulin resistance 2 History of smoking 4,5,27 Low income 6 Previous MI 4 History of gastrointestinal bleeding 4 Lower base hemoglobin 4 Multiple cardiovascular risk factors 8,10,32 Less likely than whites…”

Section: Treatmentmentioning

confidence: 99%

“…Longer than whites More likely than whites More likely than whites Door-to-drug times 12 Prescribed aspirin 5 Survive and be discharged (when not treated with revascularization) 3 Door-to-balloon times 12 Rehospitalization (nonwhites) 11 More likely than whites Less likely than whites Recurrent AMI (nonwhites) 11 Slower transfer to revascularization hospital 14 Diagnostic cardiac catheterization 5 Recurrent AMI (5 years post-PCI) 32 Less likely than whites Catheterization 31,33 Rehospitalized for AMI (<1 year post-AMI) 18 Door-to-balloon times <90 minutes 13 Non-protocol mandated angiography (nonwhites) 11 Death (nonwhites) 11 Transfer to hospital with revascularization services 15 Use of lidocaine 6 Death following CABG (nonwhites) 28 PCI 5,7 Mortality (>30 days post-AMI) 15 PCI or CABG within 3 months of AMI 17 Mortality (5 years post-PCI) 32 Revascularization (admitted to nonrevascularization hospital) 15 Rehospitalization or death within 1 year post-CHD hospitalization 30 Revascularization 3,16,34 Adverse cardiac outcomes (1-year post revascularization) 35 6 Receive stent if undergoing PCI (nonwhites) 11 Less likely than whites Stress test 33 Procedural success with PCI (nonwhites) 11 Echocardiogram 33 Mortality <30 days post-AMI 15 Drug-eluting stents 4 Prescribed prasugrel 4 Prescribed clopidogrel 5 Prescribed GP IIb/IIIa inhibit...…”

Section: Delays Treatments Outcomesmentioning

confidence: 99%

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Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Graham

2016

Clinical Cardiology

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In the United States, different races, ethnicities, and their subgroups experience disparities regarding acute coronary syndrome (ACS) and myocardial infarction (MI). This review highlights these differences across 4 stages that comprise the ACS/MI narrative: (1) patient demographics, (2) patient comorbidities and health risks, (3) treatments and their delays, and (4) outcomes. Overall, black and Hispanic ACS/MI patients are more likely to present with comorbidities, experience longer delays before treatment, and suffer worse outcomes when compared with non‐Hispanic white patients. More specifically, across the studies analyzed, black and Hispanic ACS/MI patients were consistently more likely to be younger or female, or to have hypertension or diabetes, than non‐Hispanic white patients. ACS/MI disparities also exist among Asian populations, and these are briefly outlined. However, black, Hispanic, and non‐Hispanic white ACS/MI patients were the 3 most‐studied racial and ethnic groups, indicating that additional studies of other minority groups, such as Native Americans, Asian populations, and black and Hispanic subgroups, are needed for their utility in reducing disparities. Despite notable improvement in ACS/MI treatment quality measures over recent decades, disparities persist. Causes are complex and extend beyond the healthcare system to culture and patients' personal characteristics; sophisticated solutions will be required. Continued research has the potential to further reduce or eliminate disparities in the comorbidities, delays, and treatments surrounding ACS and MI, extending healthy lifespans of many underserved and minority populations, while reducing healthcare costs.

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Section: Treatmentmentioning

confidence: 99%

Section: Delays Treatments Outcomesmentioning

confidence: 99%

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Graham

2016

Clinical Cardiology

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“…The impact that race and ethnic differences in CHD risk factor control can have on outcomes was examined among over 65,000 patients undergoing PCI enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (PCI January 1, 2010–December 31, 2011) [21]. Compared with white patients, black patients had a greater burden of comorbidities including diabetes, hypertension, and cigarette smoking [21].…”

Section: Comorbid Conditions Chd Risk Factors and Lifestyle Factorsmentioning

confidence: 99%

Differential Outcomes by Race and Ethnicity in Patients with Coronary Heart Disease: A Contemporary Review

Mochari‐Greenberger

Mosca

2015

Curr Cardiovasc Risk Rep

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Coronary heart disease (CHD) is a leading cause of death for people of most ethnicities in the USA. However, several racial and ethnic minority groups are disproportionately burdened by CHD and experience higher mortality rates and rehospitalization rates compared with whites. Contemporary CHD research has been dedicated in part to broadening our understanding of the root causes of racial and ethnic disparities in CHD outcomes. Several factors contribute, including socioeconomic and comorbid conditions. These factors may be amenable to change, and targets for initiatives to reduce disparities and improve CHD outcomes. In this article, we review the recently published research related to the distribution and determinants of racial and ethnic differences in CHD outcomes in the USA.

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“…After controlling for patient insurance, black patients were much less likely to have stress testing than white patients, with odds ratios of 0.68 (TIMI) and 0.67 (D&F). In a separate statewide study in Michigan, Khambatta et al [21] performed an analysis of all patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). A total of 65,175 patients across 44 different hospitals were included in the study with findings revealing that black patients were less likely than white patients to receive adjunctive therapy with prasugrel (10 % vs. 14.5 %), the adjunctive antiplatelet drug with the highest efficacy, and blacks were also less likely than whites to receive a drug-eluting stent (DES), the current gold standard of coronary stents in the absence of a contraindication.…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Cardiovascular Care: A Review of Culprits and Potential Solutions

Capers

Sharalaya

2014

J. Racial and Ethnic Health Disparities

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Cardiovascular disease is the leading cause of death for white and black Americans. Despite the presence of therapies that improve survival and quality of life in cardiac patients, African-Americans continue to have the worst heart disease survival rates of all racial groups. The literature has described racial disparities in cardiovascular care for at least 25 years. We review the current status of racial disparities in four areas of cardiovascular care: automatic implantable cardioverterdefibrillator (AICD) implantations in patients at risk for sudden cardiac death, cardiac resynchronization therapy with defibrillator (CRT-D) implantation in patients with severely depressed left ventricular function and refractory heart failure, reperfusion therapy in patients presenting with acute myocardial infarction, and revascularization in patients with critical limb ischemia. We will discuss potential culprits for these disparities with a particular focus on hospital quality, physician bias, and the relative lack of diversity among cardiovascular physicians in the USA. Finally, we will discuss strategies already in progress that hold promise to reduce or eliminate racial disparities in cardiovascular care.

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The association between patient race, treatment, and outcomes of patients undergoing contemporary percutaneous coronary intervention: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)

Cited by 28 publications

References 24 publications

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Differential Outcomes by Race and Ethnicity in Patients with Coronary Heart Disease: A Contemporary Review

Racial Disparities in Cardiovascular Care: A Review of Culprits and Potential Solutions

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