In the Journals

Racial disparities exist in management, outcomes of patients with non-STEMI

Sameer Arora

During a 15-year period, black patients with non-STEMI had more comorbidities and were less likely to receive guideline-based therapies than their white counterparts, according to a study published in the Journal of the American Heart Association.

“Despite measures to standardize [non-STEMI] care, differences have persisted between black and white patients during this time interval,” Sameer Arora, MD, of the division of cardiology at the University of North Carolina School of Medicine, Chapel Hill, and colleagues wrote. “Overall reduction in comorbidity burden and consistent implementation of guideline-directed strategies are crucial to mitigate racial disparities in [non-STEMI] management.”

To investigate racial differences in non-STEMI management, researchers used data from the ARIC Community Surveillance study, which has conducted community surveillance of hospitalizations for MI in four geographically defined regions of the United States since 1987. For this analysis, researchers examined data of white (n = 11,412) and black (n = 6,343) patients with non-STEMI discharged from 2000 to 2014.

The researchers found that black patients with non-STEMI were more likely to be younger and women (mean age of black patients, 60 years; 45% women; mean age of white patients, 66 years; 38% women) and less likely to have medical insurance (88% vs. 93%) than white patients with non-STEMI. Black patients also had more comorbidities than white patients, including a history of diabetes (50% vs. 37%), chronic kidney disease (38% vs. 29%) and stroke (16% vs. 10%). Prior MI was similar between black and white patients (30% vs. 32%).

During hospital stay, researchers found that black patients were less likely than white patients to be transferred to or from another hospital (1% vs. 8%) and less often administered aspirin (85% vs. 92%), nonaspirin antiplatelet therapy (45% vs. 60%), beta-blockers (85% vs. 88%) and lipid-lowering medications (68% vs. 76%).

After researchers adjusted for demographics, year of admission, and comorbidities and clinical course, they found that black patients had a 24% lower probability of receiving nonaspirin antiplatelet therapy (RR = 0.76; 95% CI, 0.71-0.81), a 29% lower probability of angiography (RR = 0.71; 95% CI, 0.67-0.76) and a 45% lower probability of revascularization (RR = 0.55; 95% CI, 0.5-0.6) than white patients.

There was no suggestion of a changing trend over time for any non-STEMI therapy (P > .2 for all), according to the researchers.

“The underlying reasons for the observed racial differences in [non-STEMI] management are likely multifactorial,” the researchers wrote. “Black patients may compose a sicker population, a category less likely to undergo an invasive strategy and for which evidence-based treatments are systematically underutilized. However, the associations in the ARIC Community Surveillance study remained significant after accounting for comorbid conditions and in-hospital clinical course.” – by Melissa J. Webb

Disclosures: Arora reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Sameer Arora

During a 15-year period, black patients with non-STEMI had more comorbidities and were less likely to receive guideline-based therapies than their white counterparts, according to a study published in the Journal of the American Heart Association.

“Despite measures to standardize [non-STEMI] care, differences have persisted between black and white patients during this time interval,” Sameer Arora, MD, of the division of cardiology at the University of North Carolina School of Medicine, Chapel Hill, and colleagues wrote. “Overall reduction in comorbidity burden and consistent implementation of guideline-directed strategies are crucial to mitigate racial disparities in [non-STEMI] management.”

To investigate racial differences in non-STEMI management, researchers used data from the ARIC Community Surveillance study, which has conducted community surveillance of hospitalizations for MI in four geographically defined regions of the United States since 1987. For this analysis, researchers examined data of white (n = 11,412) and black (n = 6,343) patients with non-STEMI discharged from 2000 to 2014.

The researchers found that black patients with non-STEMI were more likely to be younger and women (mean age of black patients, 60 years; 45% women; mean age of white patients, 66 years; 38% women) and less likely to have medical insurance (88% vs. 93%) than white patients with non-STEMI. Black patients also had more comorbidities than white patients, including a history of diabetes (50% vs. 37%), chronic kidney disease (38% vs. 29%) and stroke (16% vs. 10%). Prior MI was similar between black and white patients (30% vs. 32%).

During hospital stay, researchers found that black patients were less likely than white patients to be transferred to or from another hospital (1% vs. 8%) and less often administered aspirin (85% vs. 92%), nonaspirin antiplatelet therapy (45% vs. 60%), beta-blockers (85% vs. 88%) and lipid-lowering medications (68% vs. 76%).

After researchers adjusted for demographics, year of admission, and comorbidities and clinical course, they found that black patients had a 24% lower probability of receiving nonaspirin antiplatelet therapy (RR = 0.76; 95% CI, 0.71-0.81), a 29% lower probability of angiography (RR = 0.71; 95% CI, 0.67-0.76) and a 45% lower probability of revascularization (RR = 0.55; 95% CI, 0.5-0.6) than white patients.

There was no suggestion of a changing trend over time for any non-STEMI therapy (P > .2 for all), according to the researchers.

“The underlying reasons for the observed racial differences in [non-STEMI] management are likely multifactorial,” the researchers wrote. “Black patients may compose a sicker population, a category less likely to undergo an invasive strategy and for which evidence-based treatments are systematically underutilized. However, the associations in the ARIC Community Surveillance study remained significant after accounting for comorbid conditions and in-hospital clinical course.” – by Melissa J. Webb

Disclosures: Arora reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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