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Racial Disparities in MI Outcomes: Searching for a Cause

Results of a prospective cohort study suggest that differences in patient characteristics at baseline play a bigger role than differences in care.

That black patients tend to fare worse after MI than white patients do is well established. To explore why, investigators conducted a prospective cohort study involving 1849 participants in PREMIER (Prospective Registry Evaluating Myocardial Infarction: Events and Recovery) who were treated for MI at 10 hospitals between January 1, 2003, and June 28, 2004. A total of 514 (27.8%) patients were black (range, 5%–93% per site). On average, compared with white patients, black patients were younger, more likely to be female and to have non–ST-segment-elevation MI, and had more comorbidities and worse socioeconomic and psychosocial status.

In the 99% of participants for whom survival status was available, unadjusted mortality estimates were 19.9% for blacks and 9.3% for whites. The hazard ratio was 2.31 but decreased to 1.29 after adjustment for patient factors and to 1.04 after further adjustment for presenting hospital. Racial differences in mortality were unaffected by in-hospital treatments. After adjustment for patient factors, black patients were nonsignificantly less likely than white patients to be rehospitalized in the first year after MI. Blacks were significantly more likely than whites to have angina at 1 year, but this difference was also attenuated by patient factors.

Comment: Although these findings confirm that black patients have worse outcomes after MI than white patients do, the disparity appeared to be based on baseline cardiac risk factors and hospital factors rather than on differences in treatment. These results suggest that strategies to reduce the racial differences in outcomes from heart attacks should focus on improving cardiac risk factors in blacks and on hospital-specific quality-of-care improvements.

— Joel M. Gore, MD

Published in Journal Watch Cardiology March 18, 2009

Citation(s):

Spertus JA et al. Factors associated with racial differences in myocardial infarction outcomes. Ann Intern Med 2009 Mar 3; 150:314.

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