Acute coronary syndromes in black Americans: is treatment different? Should it be?
Luther T Clark1, Umesh Lingegowda
1Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA. ltclark@downstate.edu
Insights
Black Americans with acute coronary syndromes (ACS) face higher risks and worse outcomes. Despite guidelines, they receive less aggressive treatment and fewer cardiac interventions compared to white Americans.
Area of Science:
- Cardiology
- Health Disparities
- Clinical Medicine
Background:
- Black Americans experience a disproportionately higher risk and poorer outcomes from acute coronary syndromes (ACS) compared to White Americans.
- Contributing factors include a greater burden of baseline risk factors, delayed medical care seeking, and underutilization of aggressive treatments in high-risk individuals.
Purpose of the Study:
- To investigate the disparities in treatment and outcomes for Black Americans experiencing acute coronary syndromes (ACS).
- To highlight the paradox of Black patients with ACS receiving less aggressive care despite higher risk.
Main Methods:
- Comparative analysis of treatment strategies and outcomes based on race in patients with acute coronary syndromes (ACS).
- Review of risk factors, patient delays, and utilization of cardiac interventions (catheterization, PCI, bypass surgery).
Main Results:
- Black Americans with ACS paradoxically receive less aggressive medical therapy compared to White Americans.
- Black patients are less frequently referred for critical cardiac interventions such as cardiac catheterization, percutaneous coronary interventions (PCI), and bypass surgery.
Conclusions:
- Current treatment patterns for ACS in Black Americans are suboptimal and require significant improvement.
- Effective strategies are needed to reduce patient delays, ensure earlier diagnosis, and implement evidence-based guidelines more equitably for Black patients with ACS.
Abstract:
Black Americans with acute coronary syndromes (ACS) are at greater risk and have poorer outcomes than white Americans. The reasons for this appears, at least in part, to be due to a greater burden of baseline risk factors, longer delays prior to seeking medical care, and underutilization of aggressive treatment strategies in high-risk individuals. A guiding principle of treatment of ACS is that patients at highest risk should receive the most immediate and aggressive therapy. However, compared with whites, blacks with ACS paradoxically receive less aggressive medical therapy, and are less often referred for cardiac catheterization, percutaneous coronary interventions, and bypass surgery. Treatment is--but should not be--different in black Americans. Changing this and improving care for ACS in blacks requires better strategies for decreasing patient delays, earlier recognition and diagnosis of ACS, and more effective implementation of evidence-based treatment guidelines.
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