Mortality and use of revascularisation in black and white patients with acute MI

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Authors:

Popescu I et al

June 26, 2007

Summary:

This retrospective cohort study compared outcomes by race for 1,215,924 patients admitted to hospital with acute myocardial infarction (MI). Patients admitted to hospitals without revascularisation services were less likely to be transferred if they were black than white (25.2 vs 31.0% respectively, p < 0.001). Regardless whether the admitting hospital had revascularisation services, black patients were significantly less likely to undergo revascularisation and had significantly greater mortality at 1-year. These results remained after adjustment for sociodemographic factors, comorbidity, and illness severity. The authors concluded that “the higher long-term mortality of black patients may reflect the lower use of revascularization or other aspects of acute MI care.

Comment:

Ethnic differences in the use of coronary revascularisation after acute myocardial infarction have been documented in the US and here in Aotearoa. This study attempts to investigate the contribution of system factors to inequalities in health care (receipt of cardiovascular procedures), and asks whether ethnic disparities in the US are a consequence of ethnic differences in admission to hospitals lacking revascularization services. The authors found that compared with white patients, African American patients admitted to hospitals without revascularisation services were less likely to be transferred to hospitals with the service, were less likely to undergo revascularisation even in hospitals with revascularisation, and had higher 1-year mortality rates. Although differences in the quality of health care can occur at four major levels – system level, with the physician and their decision making, during the physician-patient interaction or patient related factors – the focus has often been on patient factors. The results from studies such as this force a shift in ‘gaze’ so that planning for appropriate interventions is undertaken.

Reference: JAMA 2007. 297; (22):2489-2495

Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

Mortality and use of revascularisation in black and white patients with acute MI

Independent commentary by Dr. Matire Hardwood

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Mortality and use of revascularisation in black and white patients with acute MI

Independent commentary by Dr. Matire Hardwood

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