Race and sex disparities in heart attack care, survival not improving

August 26, 2005

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 write in the August 18 issue of New England Journal of Medicine.

One of the largest national studies on the topic, the research showed that use of clinically recommended treatments, including aspirin, beta-blockers and reperfusion therapy (use of a drug or invasive catheter procedure 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 Harlan M. Krumholz, M.D., 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 first author Viola Vaccarino, M.D., 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 second 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.

Other study authors included Nannette Wenger of Emory University School of Medicine, Paul D. Frederick of the Ovation Research Group, Jerome L. Abramson and Susmita Malik of Emory, Ajay Manhapra of Hackley Hospital, Spring Lake, Michigan and Hale Barron of Genentech, Inc., in South San Francisco, California.
-end-
Harlan Krumholz may be contacted at 203-737-1717 or harlan.krumholz@yale.edu.
Citation: NEJM August 18, 2005; Volume 353, No. 7.

Yale University

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