Racial and Ethnic Differences in the Treatment of Acute Myocardial Infarction

Cohen, Mauricio G.; Fonarow, Gregg C.; Peterson, Eric D.; Moscucci, Mauro; Dai, David; Hernandez, Adrian F.; Bonow, Robert O.; Smith, Sidney C.

doi:10.1161/circulationaha.109.922286

Cited by 134 publications

(87 citation statements)

References 37 publications

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“…Similarly, an analysis of the Get with the Guidelines-Coronary Artery Disease (GWTG-CAD) program between January 2002 and June 2007 found that post MI, black patients had significantly lower use of aspirin at discharge and were less likely to receive guidelinedirected medical therapy. 26 Similar observations were noted with regards to lipid lowering therapies (at discharge) within the National Registry of Myocardial Infarction database. 27 In our study, however, a racial discrepancy in discharge medications was seen after CEA but not after CAS.…”

Section: Postprocedures Discharge Medicationssupporting

confidence: 66%

Racial/Ethnic Variation in Carotid Artery Revascularization Utilization and Outcomes

Wayangankar

Kennedy

Aronow

et al. 2015

Stroke

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Background and Purpose— It is not known whether racial or ethnic disparities observed with other revascularization procedures are also seen with carotid artery stenting (CAS) and endarterectomy (CEA). Methods— We compared the utilization and outcomes of CAS and CEA across racial/ethnic groups within the CARE Registry between May 2007 and December 2012. Results— Between 2007 and 2012, of the 13 129 patients who underwent CAS, majority were non-Hispanic whites (89.3%), followed by blacks (4.4%), Hispanics (4.3%), and other groups (2.0%). A similar distribution was observed among the 10 953 patients undergoing CEA (non-Hispanic whites, 92.6%; blacks, 3.5%; Hispanics, 2.8%; and other groups, 1.1%). During this time period, a trend toward proportionate increase in CAS utilization was observed in non-Hispanic whites and other groups, whereas the opposite was observed among Hispanics and blacks. This trend persisted even when hospitals performing both CAS and CEA were exclusively analyzed. Adherence to antiplatelet and statin therapy was significantly lower among blacks post CEA. In-hospital major adverse cardiac and cerebrovascular events remained comparable across groups post CAS and CEA. At 30 days, the incidence of stroke (7.2%) and major adverse cardiac and cerebrovascular events (8.8%) was higher among blacks post CEA ( P <0.05), after risk adjustment. Conclusion— During the study period, utilization of CAS and CEA was highest among non-Hispanic whites. There was a trend toward increased CAS utilization over time among non-Hispanic whites and other groups, and a trend toward increased CEA utilization among Hispanics and blacks. In-hospital major adverse cardiac and cerebrovascular events remained comparable between groups, whereas 30-day major adverse cardiac and cerebrovascular events were significantly higher in blacks.

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Section: Postprocedures Discharge Medicationssupporting

confidence: 66%

Racial/Ethnic Variation in Carotid Artery Revascularization Utilization and Outcomes

Wayangankar

Kennedy

Aronow

et al. 2015

Stroke

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“…The GWTG‐CAD database was launched in 2000 and represents a national, prospective, observational registry and quality improvement initiative established by the American Heart Association (AHA) 7, 8, 9, 10. It is a collaborative effort among researchers, professional organizations, and hospitals to provide feedback on performance and strategies to improve the care of patients with CAD.…”

Section: Methodsmentioning

confidence: 99%

Temporal Trends in Care and Outcomes of Patients Receiving Fibrinolytic Therapy Compared to Primary Percutaneous Coronary Intervention: Insights From the Get With The Guidelines Coronary Artery Disease (GWTG‐CAD) Registry

Hira

Bhatt

Fonarow

et al. 2016

JAHA

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BackgroundTimely reperfusion after ST‐elevation myocardial infarction (STEMI) improves survival. Guidelines recommend primary percutaneous coronary intervention (PPCI) within 90 minutes of arrival at a PCI‐capable hospital. The alternative is fibrinolysis within 30 minutes for those in those for whom timely transfer to a PCI‐capable hospital is not feasible.Methods and ResultsWe identified STEMI patients receiving reperfusion therapy at 229 hospitals participating in the Get With the Guidelines—Coronary Artery Disease (GWTG‐CAD) database (January 1, 2003 through December 31, 2008). Temporal trends in the use of fibrinolysis and PPCI, its timeliness, and in‐hospital mortality outcomes were assessed. We also assessed predictors of fibrinolysis versus PPCI and compliance with performance measures. Defect‐free care was defined as 100% compliance with all performance measures. We identified 29 190 STEMI patients, of whom 2441 (8.4%) received fibrinolysis; 38.2% of these patients achieved door‐to‐needle times ≤30 minutes. Median door‐to‐needle times increased from 36 to 60 minutes (P=0.005) over the study period. Among PPCI patients, median door‐to‐balloon times decreased from 94 to 64 minutes (P<0.0001) over the same period. In‐hospital mortality was higher with fibrinolysis than with PPCI (4.6% vs 3.3%, P=0.001) and did not change significantly over time. Patients receiving fibrinolysis were less likely to receive defect‐free care compared with their PPCI counterparts.ConclusionsUse of fibrinolysis for STEMI has decreased over time with concomitant worsening of door‐to‐needle times. Over the same time period, use of PPCI increased with improvement in door‐to‐balloon times. In‐hospital mortality was higher with fibrinolysis than with PPCI. As reperfusion for STEMI continues to shift from fibrinolysis to PPCI, it will be critical to ensure that door‐to‐needle times and outcomes do not worsen.

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“…1,5,7,8,24,[27][28][29][30] Although this did not affect their short-term mortality in which they had a survival advantage, it is clear that blacks did not maintain that same trajectory of survival over whites. This convergence of longterm survival may be due to a combination of less revascularization and accelerated progression of complications from their comorbidities and postdischarge influences that were not adequately captured in this analysis.…”

Section: Long-term Mortalitymentioning

confidence: 99%

Differences in Short-Term Versus Long-Term Outcomes of Older Black Versus White Patients With Myocardial Infarction

et al. 2014

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Background-Blacks are less likely than whites to receive coronary revascularization and evidence-based therapies after acute myocardial infarction, yet the impact of these differences on long-term outcomes is unknown. Methods and Results-We linked Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes WithEarly Implementation of American College of Cardiology/American Heart Association Guidelines (CRUSADE) registry data to national Medicare claims, creating a longitudinal record of care and outcomes among 40 500 patients with non-STsegment-elevation myocardial infarction treated at 446 hospitals to examine mortality and readmission rates (mean follow-up, 2.4 years) among black and white patients. Relative to whites (n=37 384), blacks (n=3116) were more often younger and female; more often had diabetes mellitus and renal failure; and received less aggressive interventions, including cardiac catheterization (60.7% versus 54.0%; P<0.001), percutaneous coronary intervention (32.1% versus 23.8%; P<0.001), and coronary bypass surgery (9.2% versus 5.7%; P<0.001). Although blacks had lower 30-day mortality (9.1% versus 9.9%; adjusted hazard ratio, 0.80; 95% confidence interval, 0.71-0.92), they had higher observed mortality at 1 year (27.9% versus 24.5%; P<0.001), although this was not significant after adjustment on long-term follow-up (hazard ratio, 1.00; 95% confidence interval, 0.94-1.07). Black patients also had higher 30-day (23.6% versus 20.0%; P<0.001) and 1-year (62.0% versus 54.6%; P<0.001) all-cause readmission, but these differences were no longer significant after risk adjustment on 30-day (hazard ratio, 1.02; 95% confidence interval, 0.92-1.13) and long-term (hazard ratio, 1.05; 95% confidence interval, 1.00-1.11) follow-up. Conclusions-Although older blacks with an acute myocardial infarction had lower initial mortality rates than whites, this early survival advantage did not persist during long-term follow-up. The reasons for this are multifactorial but may include differences in comorbidities and postdischarge care. Methods Data SourcesThe CRUSADE registry was a voluntary observational data collection and quality-improvement initiative that collected prospective data on patients with non-ST-segment elevation acute coronary syndrome from January 2001 to December 2006. CRUSADE was designed to track guideline adherence, to provide feedback about performance, and to develop quality improvement tools to improve adherence to ACC/AHA recommendations for the treatment of acute coronary syndrome patients. 9 Inclusion and exclusion criteria, data collection, and variables have previously been described. 9 The individual institutional review board of each reporting hospital approved participation in CRUSADE. All data were abstracted retrospectively and anonymously; therefore, informed consent was not required.The process of linking clinical registry data to CMS administrative data has been described previously.10 Briefly, we used indirect identifiers (ie, site, age, admission and dis...

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Racial and Ethnic Differences in the Treatment of Acute Myocardial Infarction

Cited by 134 publications

References 37 publications

Racial/Ethnic Variation in Carotid Artery Revascularization Utilization and Outcomes

Racial/Ethnic Variation in Carotid Artery Revascularization Utilization and Outcomes

Temporal Trends in Care and Outcomes of Patients Receiving Fibrinolytic Therapy Compared to Primary Percutaneous Coronary Intervention: Insights From the Get With The Guidelines Coronary Artery Disease (GWTG‐CAD) Registry

Differences in Short-Term Versus Long-Term Outcomes of Older Black Versus White Patients With Myocardial Infarction

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