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Racial Differences in Acute MI Care

New evidence that black patients with AMI are less likely to receive coronary revascularization and that they have higher long-term mortality rates than white patients

Although multiple studies have shown racial differences in quality of care for acute coronary syndromes, few have explored this phenomenon in hospitals without coronary revascularization services. In a new study, investigators analyzed data from 1,215,924 black and white Medicare beneficiaries 68 years or older with acute MI (AMI) who were admitted to any of 4627 U.S. hospitals. Of these hospitals, 3488 did not offer full revascularization services.

Among patients admitted to hospitals without revascularization services, black patients were significantly less likely than white patients to be transferred elsewhere for revascularization, either within 2 days (7% vs. 12%) or within 30 days (25% vs. 31%) of admission. Whether or not they were admitted to hospitals with revascularization services, black patients were less likely to receive revascularization than were white patients (34% vs. 50% admitted to hospitals with services, and 18% vs. 26% admitted to hospitals without services). Even when they were transferred to hospitals with revascularization services, black patients remained significantly less likely than white patients to undergo revascularization. Although black patients had lower 30-day mortality rates than did white patients, they had significantly higher longer-term mortality rates.

Comment: This study does not address the question of whether higher revascularization rates lead to better outcomes. However, these results do confirm substantial racial differences in quality of care and outcomes in AMI patients and provide important new information on racial differences in access to care (as reflected by transfer rates) and in revascularization rates. Further studies should be undertaken to identify obstacles to providing high-quality, consistent care to all AMI patients, regardless of race or admitting hospital.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology June 20, 2007

Citation(s):

Popescu I et al. Differences in mortality and use of revascularization in black and white patients with acute MI admitted to hospitals with and without revascularization services. JAMA 2007 Jun 13; 297:2489-95.

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