Racial Differences in Quality of Care and Outcomes After Acute Coronary Syndrome

Yong, Celina M.; Ungar, Leo; Abnousi, Freddy; Asch, Steven M.; Heidenreich, Paul A.

doi:10.1016/j.amjcard.2018.02.036

Cited by 40 publications

(44 citation statements)

References 43 publications

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“…Decisions to employ temporary MCS device selection are based on several factors including the severity of CS, level of hemodynamic support required, patient comorbidities, and technical limitations [4,5]. Due to the need for significant resource allocation and technical support, it is conceivable that health care inequalities due to patient demographics such as age, sex and race may arise in this population, similar to that in other conditions in acute cardiovascular care [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock

Vojjini

Patlolla

Cheungpasitporn

et al. 2021

JCM

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Racial disparities in utilization and outcomes of mechanical circulatory support (MCS) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS) are infrequently studied. This study sought to evaluate racial disparities in the outcomes of MCS in AMI-CS. The National Inpatient Sample (2012–2017) was used to identify adult AMI-CS admissions receiving MCS support. MCS devices were classified as intra-aortic balloon pump (IABP), percutaneous left ventricular assist device (pLVAD) or extracorporeal membrane oxygenation (ECMO). Self-reported race was classified as white, black and others. Outcomes included in-hospital mortality, hospital length of stay and discharge disposition. During this period, 90,071 admissions were included with white, black and other races constituting 73.6%, 8.3% and 18.1%, respectively. Compared to white and other races, black race admissions were on average younger, female, with greater comorbidities, and non-cardiac organ failure (all p < 0.001). Compared to the white race (31.3%), in-hospital mortality was comparable in black (31.4%; adjusted odds ratio (aOR) 0.98 (95% confidence interval (CI) 0.93–1.05); p = 0.60) and other (30.2%; aOR 0.96 (95% CI 0.92–1.01); p = 0.10). Higher in-hospital mortality was noted in non-white races with concomitant cardiac arrest, and those receiving ECMO support. Black admissions had longer lengths of hospital stay (12.1 ± 14.2, 10.3 ± 11.2, 10.9 ± 1.2 days) and transferred less often (12.6%, 14.2%, 13.9%) compared to white and other races (both p < 0.001). In conclusion, this study of AMI-CS admissions receiving MCS devices did not identify racial disparities in in-hospital mortality. Black admissions had longer hospital stay and were transferred less often. Further evaluation with granular data including angiographic and hemodynamic parameters is essential to rule out racial differences.

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Section: Introductionmentioning

confidence: 99%

Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock

Vojjini

Patlolla

Cheungpasitporn

et al. 2021

JCM

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“…This population experiences longer delays in door-to-balloon times and door-to-drug times compared with Whites. 16,18 Additionally, AA patients are less likely to receive percutaneous coronary intervention, angiography, drug-eluting stents, and coronary artery bypass grafting. 12,18,21,22 Multiple explanations have been postulated; in part, this may be due to misdiagnosis of ACS owing to higher comorbidities or lack of resources resulting in slower referral for procedures, deliberate refusal of angiography interventions, 12 and limitations to access with deterrence from associated costs of seeking care.…”

Section: Discussionmentioning

confidence: 99%

“…16,18 Additionally, AA patients are less likely to receive percutaneous coronary intervention, angiography, drug-eluting stents, and coronary artery bypass grafting. 12,18,21,22 Multiple explanations have been postulated; in part, this may be due to misdiagnosis of ACS owing to higher comorbidities or lack of resources resulting in slower referral for procedures, deliberate refusal of angiography interventions, 12 and limitations to access with deterrence from associated costs of seeking care. 18 Moreover, causes for the gaps in procedural rates may extend beyond health care systems and be rooted in personal motivations, including trust level, hesitancies, and preferences.…”

Section: Discussionmentioning

confidence: 99%

“…12,18,21,22 Multiple explanations have been postulated; in part, this may be due to misdiagnosis of ACS owing to higher comorbidities or lack of resources resulting in slower referral for procedures, deliberate refusal of angiography interventions, 12 and limitations to access with deterrence from associated costs of seeking care. 18 Moreover, causes for the gaps in procedural rates may extend beyond health care systems and be rooted in personal motivations, including trust level, hesitancies, and preferences. 16 This reluctance in receiving care may be associated with the poorer outcomes observed, including repeat hospitalization and mortality rates.…”

Section: Discussionmentioning

confidence: 99%

“…16 Surprisingly, when compared with other ethnic groups, AAs were least likely to present with STEMI despite the prevalence of comorbid conditions. 18…”

Section: Risk Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Examining Acute Coronary Syndrome Across Ethnicity, Sex, and Age

Leon¹,

Winokur²

2022

The Journal for Nurse Practitioners

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Temporal trends in transcatheter aortic valve replacement use and outcomes by race, ethnicity, and sex

Yong

Jaluba

Batchelor

et al. 2022

Cathet Cardio Intervent

Self Cite

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Objectives: To identify trends in transcatheter aortic valve replacement (TAVR) use and outcomes by race (non-Hispanic White, Black), ethnicity (Hispanic), and sex over time.Background: Despite rapid growth in TAVR use over time, our understanding of its use and outcomes among males and females of underrepresented racial/ethnic groups remains limited.Methods: A retrospective analysis of hospitalizations from 2013 to 2017 from the Healthcare Cost and Utilization Project database was performed.Results: White patients comprised 65% (n = 2.16 × 10 7 ) of all hospitalizations, yet they comprised 83% (n = 176,887) of the admissions for aortic stenosis (p < 0.0001).Among 91,693 hospitalizations for aortic valve replacement, 64,069 were surgical (34.0% female, 7.0% Hispanic, and 5.9% Black) and 27,624 were transcatheter (46.6% female, 4.5% Hispanic, and 4.4% Black). Growth in TAVR volumes was the slowest among minorities and females. Hispanic males, Hispanic females, and White females had the highest in-hospital mortality (2.7%-3.3%; compared to White males, adjusted odds ratio: Hispanic males 1.9 [1.2-3.0], Hispanic females 1.9 [1.2-3.1],and White females 1.4 [1.2-1.7]). Despite less baseline vascular disease, females of all races/ethnicities had more vascular complications than men (female 5% vs. male 3.5%, p ≤ 0.001). Further adjustment for vascular complications only partially attenuated mortality differences. Black and Hispanic patients had a longer mean length of hospital stay than White patients, which was most pronounced among females. Pacemaker requirements were consistently low among all groups.Conclusion: Differences in TAVR growth and outcomes by race, ethnicity, and sex over time highlight areas for focused efforts to close gaps in minimally invasive structural heart disease care.

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Racial Differences in Quality of Care and Outcomes After Acute Coronary Syndrome

Cited by 40 publications

References 43 publications

Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock

Racial Disparities in the Utilization and Outcomes of Temporary Mechanical Circulatory Support for Acute Myocardial Infarction-Cardiogenic Shock

Examining Acute Coronary Syndrome Across Ethnicity, Sex, and Age

Temporal trends in transcatheter aortic valve replacement use and outcomes by race, ethnicity, and sex

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