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Racial disparities in treatment following ACS

In the United States, post myocardial infarction care has previously been noted to differ among races and, in particular, the use of invasive techniques is known to be lower in African American patients. As less than one-fifth of American acute care hospitals perform coronary revascularisation, it is important to study patients admitted to those hospitals without these facilities if we are to understand this disparity fully.

Popescu and colleagues studied patterns of care between black and white patients according to whether they were admitted to a hospital with or without cardiac revascularisation services. To do this they retrospectively studied 1 215 924 black and white patients aged 68 and over, all of whom had been admitted between January 2000 and June 2005. The main outcome measures studied were the risk-adjusted rates of 30-day coronary revascularisation and 1-year mortality; for patients admitted to hospitals without revascularisation facilities, the frequency of transfer to a tertiary centre was also measured.

Overall, black patients were less likely to be transferred from hospitals without revascularisation facilities (25.2% vs 31.0%; p<0.001). Regardless of whether the hospital had revascularisation services or not, black patients were less likely to undergo revascularisation than white patients (34.3% vs 50.2% in hospitals with revascularisation services, 18.3% vs 25.9% in those without; p<0.001) and also had higher 1-year mortality (35.3% vs 30.2%, 39.7% vs 37.6%; p<0.001). These results remained constant even after adjustment for sociodemographics, comorbidity and illness severity.

Therefore even after transfer, black patients were less likely to receive revascularisation. What are the reasons for these differences? Perhaps patient preferences, clinical presentation, or unmeasured socioeconomic factors are influential. Although this study does not answer this question, our understanding of the problem is at least enhanced.

Popescu I, Vaughan-Sarrazin MS, Rosenthal GE. Differences in mortality and use of revascularization in black and white patients …

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