Differences in Treatment Patterns and Outcomes Between Hispanics and Non-Hispanic Whites Treated for ST-Segment Elevation Myocardial Infarction

Guzmán, Luis A.; Li, Shuang; Wang, Tracy Y.; Daviglus, Martha L.; Exaire, J. Emilio; Rodríguez, Carlos J.; Torres, Vilma; Funk, Marjorie; Saucedo, Jorge; Granger, C.B.; Piña, Ileana L.; Cohen, Mauricio G.

doi:10.1016/j.jacc.2011.10.882

Cited by 37 publications

(43 citation statements)

References 5 publications

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“…20 Despite longer times to STEMI triage, reperfusion, and less use of evidence-based discharge care, Hispanics and non-Hispanic whites in this study had similar clinical outcomes. 20 In the study of patients in the RENASICA-CRUSADE registries, mortality outcomes were similar in Hispanics and nonHispanic whites. 21 Similarly, in STEMI patients undergoing primary PCI as part of the GWTG study, investigators found no association between race/ethnicity and in-hospital mortality.…”

Section: Discussionmentioning

confidence: 66%

“…12 In STEMI patients undergoing primary PCI as part of the GWTG study, median door-toballoon times were marginally, but not significantly, longer for Hispanic patients than for non-Hispanic white patients, and Hispanic ethnicity was not associated with reduced odds of door-to-balloon times ≤90 minutes (a quality-of-care indicator for treatment of STEMI). 13 In the ACTION Registry-GWTG study, use of acute medications and primary PCI was similar in Hispanic and non-Hispanic patient groups, 20 and Hispanic patients in the NYS-PCI-RS study were found to have higher rates of surgical or PCI revascularization. 22 Other studies show lower rates of revascularization for Hispanic patients.…”

Section: Treatment and Medicationmentioning

confidence: 99%

“…In the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-GWTG study, Hispanic patients were more likely than non-Hispanic white patients to have diabetes, but less likely to have had a previous MI or prior revascularization. 20 Hispanic patients with STEMI from the New York State PCI Reporting System 300 Clin. Cardiol.…”

Section: Comorbiditiesmentioning

confidence: 99%

“…In the ACTION Registry-GWTG study, investigators found significant delays in triage and reperfusion in Hispanic patients compared to non-Hispanic white patients. 20 In a study on a large cohort of patients from the National Registry of Myocardial Infarction from 1999 to 2002, door-to-drug and door-to-balloon times were significantly longer for Hispanic patients than for white patients when receiving primary PCI for STEMI, although some of this disparity was attributed to treatment hospitals. 12 In STEMI patients undergoing primary PCI as part of the GWTG study, median door-toballoon times were marginally, but not significantly, longer for Hispanic patients than for non-Hispanic white patients, and Hispanic ethnicity was not associated with reduced odds of door-to-balloon times ≤90 minutes (a quality-of-care indicator for treatment of STEMI).…”

Section: Treatment and Medicationmentioning

confidence: 99%

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Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Graham

2016

Clinical Cardiology

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In the United States, different races, ethnicities, and their subgroups experience disparities regarding acute coronary syndrome (ACS) and myocardial infarction (MI). This review highlights these differences across 4 stages that comprise the ACS/MI narrative: (1) patient demographics, (2) patient comorbidities and health risks, (3) treatments and their delays, and (4) outcomes. Overall, black and Hispanic ACS/MI patients are more likely to present with comorbidities, experience longer delays before treatment, and suffer worse outcomes when compared with non‐Hispanic white patients. More specifically, across the studies analyzed, black and Hispanic ACS/MI patients were consistently more likely to be younger or female, or to have hypertension or diabetes, than non‐Hispanic white patients. ACS/MI disparities also exist among Asian populations, and these are briefly outlined. However, black, Hispanic, and non‐Hispanic white ACS/MI patients were the 3 most‐studied racial and ethnic groups, indicating that additional studies of other minority groups, such as Native Americans, Asian populations, and black and Hispanic subgroups, are needed for their utility in reducing disparities. Despite notable improvement in ACS/MI treatment quality measures over recent decades, disparities persist. Causes are complex and extend beyond the healthcare system to culture and patients' personal characteristics; sophisticated solutions will be required. Continued research has the potential to further reduce or eliminate disparities in the comorbidities, delays, and treatments surrounding ACS and MI, extending healthy lifespans of many underserved and minority populations, while reducing healthcare costs.

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Section: Discussionmentioning

confidence: 66%

Section: Treatment and Medicationmentioning

confidence: 99%

Section: Comorbiditiesmentioning

confidence: 99%

Section: Treatment and Medicationmentioning

confidence: 99%

See 2 more Smart Citations

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Graham

2016

Clinical Cardiology

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“…Using 46,245 STEMI patients from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcome Network-Get With The Guidelines Registry (ACTION Registry-GWTG), Guzman compared treatment of Hispanic patients to that of non-Hispanic Caucasians [64]. Hispanics had longer time of symptom onset to hospital arrival, arrival to ECG, and door-to-balloon time.…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions

Leigh

Alvarez

Rodríguez

2016

Curr Atheroscler Rep

Self Cite

132

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Heart disease remains the leading cause of death in the USA. Overall, heart disease accounts for about 1 in 4 deaths with coronary heart disease (CHD) being responsible for over 370,000 deaths per year. It has frequently and repeatedly been shown that some minority groups in the USA have higher rates of traditional CHD risk factors, different rates of treatment with revascularization procedures, and excess morbidity and mortality from CHD when compared to the non-Hispanic white population. Numerous investigations have been made into the causes of these disparities. This review aims to highlight the recent literature which examines CHD in ethnic minorities and future directions in research and care.

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Evaluation of STEMI Regionalization on Access, Treatment, and Outcomes Among Adults Living in Nonminority and Minority Communities

2020

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IMPORTANCE Cardiac care regionalization, specifically for patients with ST-segment elevation myocardial infarction (STEMI), has been touted as a potential mechanism to reduce systematic disparities by protocolizing the treatment of these conditions. However, it is unknown whether such regionalization arrangements have widened or narrowed disparities in access, treatment, and outcomes for minority communities.OBJECTIVE To determine the extent to which disparities in access, treatment, and outcomes have changed for patients with STEMI living in zip codes that are in the top tertile of the Black or Hispanic population compared with patients in nonminority zip codes in regionalized vs nonregionalized counties. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used a quasi-experimental approach exploiting the different timing of regionalization across California. Nonpublic inpatient data for all patients with STEMI from January 1, 2006, to October 31, 2015, were analyzed using a difference-indifference-in-differences estimation approach. EXPOSURE Exposure to the intervention was defined as on and after the year a patient's county was exposed to regionalization. MAIN OUTCOMES AND MEASURES Access to percutaneous coronary intervention (PCI)-capablehospital, receipt of PCI on the same day and at any time during the hospitalization, and time-specific all-cause mortality. RESULTSThis study included 139 494 patients with STEMI; 61.9% of patients were non-Hispanic White, 5.6% Black, 17.8% Hispanic, and 9.0% Asian; 32.8% were women. Access to PCI-capable hospitals improved by 6.3 percentage points (95% CI, 5.5 to 7.1 percentage points; P < .001) when patients in nonminority communities were exposed to regionalization. Patients in minority communities experienced a 1.8-percentage point smaller improvement in access (95% CI, −2.8 to −0.8 percentage points; P < .001), or 28.9% smaller, compared with those in nonminority communities when both were exposed to regionalization. Regionalization was associated with an improvement to same-day PCI and in-hospital PCI by 5.1 percentage points (95% CI, 4.2 to 6.1 percentage points; P < .001) and 5.0 percentage points (95% CI, 4.2 to 5.9 percentage points; P < .001), respectively, for patients in nonminority communities. Patients in minority communities experienced only 33.3% and 15.1% of that benefit. Only White patients in nonminority communities experienced mortality improvement from regionalization.

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Differences in Treatment Patterns and Outcomes Between Hispanics and Non-Hispanic Whites Treated for ST-Segment Elevation Myocardial Infarction

Cited by 37 publications

References 5 publications

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions

Evaluation of STEMI Regionalization on Access, Treatment, and Outcomes Among Adults Living in Nonminority and Minority Communities

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