New Haven, Conn. -- Differences based on race and sex in treatmentpatterns for hospitalized American heart attack patients have remainedunchanged over an eight-year period, despite improvements in quality ofheart attack care during this time, Emory and Yale School of Medicineresearchers write in the August 18 issue of New England Journal ofMedicine.
One of the largest national studies on the topic, the researchshowed that use of clinically recommended treatments, includingaspirin, beta-blockers and reperfusion therapy (use of a drug orinvasive catheter procedure to open an artery blocked by a clot) werelower in women and black patients with a heart attack. Some of thesedifferences were explained by other patient characteristics.
Additionally, cardiac catheterization, a diagnostic procedureused to identify blockages in the heart's circulation commonlyperformed in patients after a heart attack, was also used lessfrequently in women and black patients with a heart attack.
"What concerns me most is that we found persistence of anelevated risk of death among African American women," said seniorauthor Harlan M. Krumholz, M.D., professor of medicine and publichealth at Yale School of Medicine. "This finding, along with evidenceof differences in treatment, requires attention and remedy."
The authors used data from the National Registry of MyocardialInfarction-3 and -4, a registry of 589,911 patients hospitalized forheart attacks throughout the United States between 1994 and 2002,sponsored by the Genentech, Inc. The team evaluated whether race andsex differences in treatment that had been previously reported in heartattack care had changed in subsequent years.
"Lower rates of treatment in patients who are clinicallyappropriate for treatment are troubling and raise obvious concernsabout 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, riskfactors or other clinical characteristics that might differ betweenpatients. We simply could not determine the reasons for thesedifferences."Saif Rathore, a third year medical student at Yale and the study'ssecond author said, "Continued race and sex disparities suggest thatthe solution may rely more onhealth-system related factors. The lack of change suggests thatwhatever process accounts for these differences is an inherent part ofthe health care system that isn't remedied by simply increasingawareness of these differences."
Rathore said that while some may suggest bias, there may beother explanations, such as beginning to examine differences in howthese patients receive care, including possible differences in thequality of hospitals and physicians that treat these populations.
Other study authors included Nannette Wenger of EmoryUniversity School of Medicine, Paul D. Frederick of the OvationResearch Group, Jerome L. Abramson and Susmita Malik of Emory, AjayManhapra of Hackley Hospital, Spring Lake, Michigan and Hale Barron ofGenentech, Inc., in South San Francisco, California.
Cite This Page: