Racial and ethnic differences in the use of cardiovascular procedures: findings from the California Cooperative Cardiovascular Project

Ford, Earl S.; Newman, Jeffrey; Deosaransingh, Kamala

doi:10.2105/ajph.90.7.1128

Cited by 43 publications

(4 citation statements)

References 60 publications

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“…In the implementation of evidence-based reperfusion strategies, doctors have to make the best decision to allocate limited resources to patients who are at highest risk and hope to obtain the largest benefit. Many studies have found differences in the delivery of cardiac care and reperfusion procedure among different ethnic groups in ACS [ 77 - 79 ]. Earlier studies of ethnic variation in the treatment and outcome of ACS in USA showed that non-whites had longer door-to-needle time in the treatment of AMI [ 80 ] and were less likely to undergo invasive cardiac procedures [ 81 , 82 ].…”

Section: Discussionmentioning

confidence: 99%

Ethnic differences in the occurrence of acute coronary syndrome: results of the Malaysian National Cardiovascular Disease (NCVD) Database Registry (March 2006 - February 2010)

Nordin

2013

BMC Cardiovasc Disord

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BackgroundThe National Cardiovascular Disease (NCVD) Database Registry represents one of the first prospective, multi-center registries to treat and prevent coronary artery disease (CAD) in Malaysia. Since ethnicity is an important consideration in the occurrence of acute coronary syndrome (ACS) globally, therefore, we aimed to identify the role of ethnicity in the occurrence of ACS among high-risk groups in the Malaysian population.MethodsThe NCVD involves more than 15 Ministry of Health (MOH) hospitals nationwide, universities and the National Heart Institute and enrolls patients presenting with ACS [ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA)]. We analyzed ethnic differences across socio-demographic characteristics, hospital medications and invasive therapeutic procedures, treatment of STEMI and in-hospital clinical outcomes.ResultsWe enrolled 13,591 patients. The distribution of the NCVD population was as follows: 49.0% Malays, 22.5% Chinese, 23.1% Indians and 5.3% Others (representing other indigenous groups and non-Malaysian nationals). The mean age (SD) of ACS patients at presentation was 59.1 (12.0) years. More than 70% were males. A higher proportion of patients within each ethnic group had more than two coronary risk factors. Malays had higher body mass index (BMI). Chinese had highest rate of hypertension and hyperlipidemia. Indians had higher rate of diabetes mellitus (DM) and family history of premature CAD. Overall, more patients had STEMI than NSTEMI or UA among all ethnic groups. The use of aspirin was more than 94% among all ethnic groups. Utilization rates for elective and emergency percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) were low among all ethnic groups. In STEMI, fibrinolysis (streptokinase) appeared to be the dominant treatment options (>70%) for all ethnic groups. In-hospital mortality rates for STEMI across ethnicity ranges from 8.1% to 10.1% (p = 0.35). Among NSTEMI/UA patients, the rate of in-hospital mortality ranges from 3.7% to 6.5% and Malays recorded the highest in-hospital mortality rate compared to other ethnic groups (p = 0.000). In binary multiple logistic regression analysis, differences across ethnicity in the age and sex-adjusted ORs for in-hospital mortality among STEMI patients was not significant; for NSTEMI/UA patients, Chinese [OR 0.71 (95% CI 0.55, 0.91)] and Indians [OR 0.57 (95% CI 0.43, 0.76)] showed significantly lower risk of in-hospital mortality compared to Malays (reference group).ConclusionsRisk factor profiles and ACS stratum were significantly different across ethnicity. Despite disparities in risk factors, clinical presentation, medical treatment and invasive management, ethnic differences in the risk of in-hospital mortality was not significant among STEMI patients. However, Chinese and Indians showed significantly lower risk of in-hospital mortality compared to Malays among NSTEMI and UA patients.

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Section: Discussionmentioning

confidence: 99%

Ethnic differences in the occurrence of acute coronary syndrome: results of the Malaysian National Cardiovascular Disease (NCVD) Database Registry (March 2006 - February 2010)

Nordin

2013

BMC Cardiovasc Disord

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“… 4 – 7 There is evidence that racial disparities exist among African-Americans and Hispanics compared to non-Hispanic whites in access to and the use of cardiac procedures which are thought to contribute to differences in morbidity and mortality. 8 – 13 We are aware of very few previously published studies that compare the cardiovascular procedure rates among AIAN with other racial groups. 14 , 15 One found that in some geographic regions of the U.S., AIAN have lower rates of coronary revascularization than whites in the setting of acute myocardial infarction.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Procedures among American Indians and Alaska Natives compared to Non-Hispanic Whites Hospitalized with Ischemic Heart Disease in California

et al. 2010

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BackgroundAmerican Indians/Alaska Natives (AIAN) experience a high burden of cardiovascular disease with rates for fatal and nonfatal heart disease approximately twofold higher than the U.S. population.ObjectiveTo determine if disparities exist in cardiac procedure rates among AIAN compared to non-Hispanic whites hospitalized in California for ischemic heart disease defined as acute myocardial infarction or unstable angina.DesignCross-sectional study.EventsA total of 796 ischemic heart disease hospitalizations among AIAN and 90971 among non-Hispanic whites in 37 of 58 counties in California from 1998-2002.MeasurementsCardiac catheterization, percutaneous cardiac intervention, and coronary artery bypass graft surgery procedure rates from hospitalization administrative data.Main resultsAIAN did not have lower cardiac procedure rates for cardiac catheterization and percutaneous cardiac intervention compared to non-Hispanic whites (unadjusted OR 1.00, 95% CI 0.87–1.16 and OR 1.04, 95% CI 0.90–1.20, respectively). Adjustment for age, sex, comorbidities, and payer source did not alter the results (adjusted OR 0.95, 95% CI 0.82–1.10 and OR 0.98, 95% CI 0.85–1.14, respectively). We found higher odds (unadjusted OR 1.36, 95% CI 1.09–1.70) for receipt of coronary artery bypass graft surgery among AIAN hospitalized for ischemic heart disease compared to non-Hispanic whites which after adjustment attenuated some and was no longer statistically significant (adjusted OR 1.26, 95% CI 1.00–1.58).ConclusionAIAN were not less likely to receive cardiac procedures as non-Hispanic whites during hospitalizations for ischemic heart disease. Additional research is needed to determine whether differences in specialty referral patterns, patients’ treatment preferences, or outpatient management may explain some of the health disparities due to cardiovascular disease that is found among AIAN.

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“… 4 , 6 , 7 , 8 , 9 , 10 , 11 , 12 Patients of Hispanic and other ethnicitie, commonly grouped as “non‐White” or “other,” have also been found to have lower rates of coronary angiography and PCI, with increased morbidity and mortality from cardiovascular disease when compared with White patients. 13 , 14 …”

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confidence: 99%

“…Discrepancies in out‐of‐hospital cardiac arrest (OOHCA) care, including lack of bystander cardiopulmonary resuscitation, lower rates of witnessed arrest, and less frequent shockable rhythms have been associated with increased mortality among racial/ethnic minorities. 13 , 14 Additionally, differences in care by hospital center may also contribute to outcomes of both OOHCA and in‐hospital cardiac arrest (IHCA), as Black and Hispanic patients are often cared for in hospitals that have been identified in national registries to have lower overall survival rates. 5 , 15 However, more recent work has shown that gaps in care are less pronounced, finding very little difference in prehospital care or outcomes by race/ethnicity in the past few years.…”

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Racial and Ethnic Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction

Subramaniam

Patlolla

Cheungpasitporn

et al. 2021

JAHA

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Background The role of race and ethnicity in the outcomes of cardiac arrest (CA) complicating acute myocardial infarction (AMI) is incompletely understood. Methods and Results This was a retrospective cohort study of adult admissions with AMI‐CA from the National Inpatient Sample (2012–2017). Self‐reported race/ethnicity was classified as White, Black, and others (Hispanic, Asian or Pacific Islander, Native American, Other). Outcomes of interest included in‐hospital mortality, coronary angiography, percutaneous coronary intervention, palliative care consultation, do‐not‐resuscitate status use, hospitalization costs, hospital length of stay, and discharge disposition. Of the 3.5 million admissions with AMI, CA was noted in 182 750 (5.2%), with White, Black, and other races/ethnicities constituting 74.8%, 10.7%, and 14.5%, respectively. Black patients admitted with AMI‐CA were more likely to be female, with more comorbidities, higher rates of non–ST‐segment–elevation myocardial infarction, and higher neurological and renal failure. Admissions of patients of Black and other races/ethnicities underwent coronary angiography (61.9% versus 70.2% versus 73.1%) and percutaneous coronary intervention (44.6% versus 53.0% versus 58.1%) less frequently compared to patients of white race ( p <0.001). Admissions of patients with AMI‐CA had significantly higher unadjusted mortality (47.4% and 47.4%) as compared with White patients admitted (40.9%). In adjusted analyses, Black race was associated with lower in‐hospital mortality (odds ratio [OR], 0.95; 95% CI, 0.91–0.99; P =0.007) whereas other races had higher in‐hospital mortality (OR, 1.11; 95% CI, 1.08–1.15; P <0.001) compared with White race. Admissions of Black patients with AMI‐CA had longer length of hospital stay, higher rates of palliative care consultation, less frequent do‐not‐resuscitate status use, and fewer discharges to home (all P <0.001). Conclusions Racial and ethnic minorities received less frequent guideline‐directed procedures and had higher in‐hospital mortality and worse outcomes in AMI‐CA.

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Racial and ethnic differences in the use of cardiovascular procedures: findings from the California Cooperative Cardiovascular Project

Cited by 43 publications

References 60 publications

Ethnic differences in the occurrence of acute coronary syndrome: results of the Malaysian National Cardiovascular Disease (NCVD) Database Registry (March 2006 - February 2010)

Ethnic differences in the occurrence of acute coronary syndrome: results of the Malaysian National Cardiovascular Disease (NCVD) Database Registry (March 2006 - February 2010)

Cardiac Procedures among American Indians and Alaska Natives compared to Non-Hispanic Whites Hospitalized with Ischemic Heart Disease in California

Racial and Ethnic Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction

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