Gender, Racial, and Geographic Differences in the Performance of Cardiac Diagnostic and Therapeutic Procedures for Hospitalized Acute Myocardial Infarction in Four States

Weitzman, S; Cooper, Lawton S.; Chambless, Lloyd E.; Rosamond, Wayne D.; Clegg, Limin X.; Marcucci, Gretchen; Romm, Fredric J.; White, Ayla O.

doi:10.1016/s0002-9149(96)00857-0

Cited by 167 publications

(52 citation statements)

References 26 publications

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“…Care differences may also be attributed to variable baseline comorbidities, treatment variation by geographic region or hospital type, or presenting characteristics making a patient a nonideal candidate for interventional therapy. [9][10][11]15,[21][22][23][24][25][26][27][28][29] However, in this study, disparities persist even after adjusting for these variables.…”

Section: Discussionmentioning

confidence: 89%

Race and Sex Differences in Management and Outcomes of Patients After ST‐Elevation and Non–ST‐Elevation Myocardial Infarct: Results From the NCDR

Anstey

Thomas

et al. 2016

Clinical Cardiology

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BackgroundRace and sex have been shown to affect management of myocardial infarction (MI); however, it is unclear if such disparities exist in contemporary care of ST‐segment elevation myocardial infarction (STEMI) and non‐ST‐segment elevation myocardial infarction (NSTEMI).HypothesisDisparities in care will be less prevalent in more heavily protocol‐driven management of STEMI than the less algorithmic care of NSTEMI.MethodsData were collected from the ACTION Registry‐GWTG database to assess care differences related to race and sex of patients presenting with NSTEMI or STEMI. For key treatments and outcomes, adjustments were made including patient demographics, baseline comorbidities, and markers of socioeconomic status.ResultsKey demographic variables demonstrate significant differences in baseline comorbidities; black patients had higher incidences of hypertension and diabetes, and women more frequently had diabetes. With few exceptions, rates of acute and discharge medical therapy were similar by race in any sex category in both STEMI and NSTEMI populations. Rates of catheterization were similar by race for STEMI but not for NSTEMI, where both black men and women had lower rates of invasive therapy. Rates of revascularization were significantly lower for black patients in both the STEMI and NSTEMI groups regardless of sex. Rates of adverse events differed by sex, with disparities for death and major bleeding; after adjustment, rates were similar by race within sex comparisons.ConclusionsIn this contemporary cohort, although there are differences by race in presentation and management of MI, heavily protocol‐driven processes seem to show fewer racial disparities.

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Section: Discussionmentioning

confidence: 89%

Race and Sex Differences in Management and Outcomes of Patients After ST‐Elevation and Non–ST‐Elevation Myocardial Infarct: Results From the NCDR

Anstey

Thomas

et al. 2016

Clinical Cardiology

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“…29 Green et al demonstrated that providers' implicit attitudes about race may contribute to the disparity in care of patients with acute coronary syndrome, 7 where Black patients are less likely than Whites to receive appropriate therapies. [45][46][47][48][49] Internal medicine and emergency medicine residents took the Black/White:Good/Bad IAT and also answered questions about a vignette of a patient with chest pain randomly designated as Black or White. Residents with greater implicit bias were significantly less likely to recommend thrombolysis for Black patients than those with less bias.…”

Section: The Effects Of Implicit Bias On Medical Decision-makingmentioning

confidence: 99%

Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities

2013

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“…11 Reports on ethnic differences in coronary interventions and fatality have largely been confined to the United States population. Several studies have shown that black patients were less likely to undergo coronary angiography, 12 PTCA, and coronary artery bypass surgery (CABG). 12,13 Even among patients who underwent coronary angiography, the patterns of subsequent revascularization differ between blacks and whites; 14 blacks were less likely to receive revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that black patients were less likely to undergo coronary angiography, 12 PTCA, and coronary artery bypass surgery (CABG). 12,13 Even among patients who underwent coronary angiography, the patterns of subsequent revascularization differ between blacks and whites; 14 blacks were less likely to receive revascularization. Other ethnic groups, including Hispanics and Asian Americans, were also less likely to undergo invasive cardiac procedures in the United States, 15 which may be "overused" among whites.…”

Section: Discussionmentioning

confidence: 99%

Ethnic differences in utilization of invasive cardiac procedures and in long‐term survival following acute myocardial infarction

Mak¹,

Kark²,

Chia³

et al. 2004

Clinical Cardiology

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SummaryBackground: Ethnic differences in coronary mortality have been documented, and South Asians from the Indian subcontinent are particularly vulnerable.Hypothesis: This study sought to determine whether there was a difference in the utilization of invasive cardiac procedures and long-term mortality in survivors of myocardial infarction (MI) among Chinese, Malays, and South Asians in Singapore.Methods: All MI events in the country were identified and defined by the Singapore Myocardial Infarction Register, which uses modified procedures of the World Health Organization MONICA Project. Information on utilization of coronary angiography, coronary angioplasty, coronary artery bypass graft, and survival was obtained by data linkage with national billing and death registries. Hazard ratios (HR) were calculated using the Cox proportional hazards model with adjustment for baseline characteristics.

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Gender, Racial, and Geographic Differences in the Performance of Cardiac Diagnostic and Therapeutic Procedures for Hospitalized Acute Myocardial Infarction in Four States

Cited by 167 publications

References 26 publications

Race and Sex Differences in Management and Outcomes of Patients After ST‐Elevation and Non–ST‐Elevation Myocardial Infarct: Results From the NCDR

Race and Sex Differences in Management and Outcomes of Patients After ST‐Elevation and Non–ST‐Elevation Myocardial Infarct: Results From the NCDR

Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities

Ethnic differences in utilization of invasive cardiac procedures and in long‐term survival following acute myocardial infarction

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