Racial and ethnic differences in the treatment of acute myocardial infarction: Findings from the get with the guidelines-coronary artery disease program

Mauricio G. Cohen, Gregg C. Fonarow, Eric D. Peterson, Mauro Moscucci, David Dai, Adrian F. Hernandez, Robert O. Bonow, Sidney C. Smith

Research output: Contribution to journalArticle

104 Scopus citations

Abstract

BACKGROUND-: Racial/ethnic differences in cardiovascular care have been well documented. We sought to determine whether racial/ethnic differences in evidence-based acute myocardial infarction care persist among hospitals participating in a national quality improvement program. METHODS AND RESULTS-: We analyzed 142 593 acute myocardial infarction patients (121 528 whites, 10 882 blacks, and 10 183 Hispanics) at 443 hospitals participating in the Get With the Guidelines-Coronary Artery Disease (GWTG-CAD) program between January 2002 and June 2007. We examined individual and overall composite rates of defect-free care, defined as the proportion of patients receiving all eligible performance measures. In addition, we examined temporal trends in use of performance measures according to race/ethnicity by calendar quarter. Overall, individual performance measure use was high, ranging from 78% for use of angiotensin-converting enzyme inhibitors to 96% for use of aspirin at discharge. Use of each of these improved significantly over the 5 years of study. Overall, defect-free care was 80.9% for whites, 79.5% for Hispanics (adjusted odds ratio versus whites 1.00, 95% confidence interval 0.94 to 1.06, P=0.94), and 77.7% for blacks (adjusted odds ratio versus whites 0.93, 95% confidence interval 0.87 to 0.98, P=0.01). A significant gap in defect-free care was observed for blacks mostly during the first half of the study, which was no longer present during the remainder of the study. Overall, progressive improvements in defect-free care were observed regardless of race/ethnic groups. CONCLUSIONS-: Among hospitals engaged in a national quality monitoring and improvement program, evidence-based care for acute myocardial infarction appeared to improve over time for patients irrespective of race/ethnicity, and differences in care by race/ethnicity care were reduced or eliminated.

Original languageEnglish (US)
Pages (from-to)2294-2301
Number of pages8
JournalCirculation
Volume121
Issue number21
DOIs
StatePublished - Jun 1 2010

Keywords

  • Epidemiology
  • Myocardial infarction
  • Outcomes
  • Registries
  • Risk factors

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

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