Racial Differences in Quality of Care and Outcomes After Acute Coronary Syndrome
Celina M Yong1, Leo Ungar2, Freddy Abnousi2
1Stanford University School of Medicine/Stanford Cardiovascular Institute, Stanford, California; VA Palo Alto Health Care System, Palo Alto, California.
Insights
Racial disparities exist in acute coronary syndrome (ACS) care. Asian patients faced higher mortality despite advanced treatments, while Black patients had better outcomes despite receiving less guideline-adherent care.
Area of Science:
- Cardiology
- Health Services Research
- Health Disparities
Background:
- Understanding racial variations in acute coronary syndrome (ACS) outcomes is crucial, especially with modern treatments like drug-eluting stents (DES).
- Previous research has not adequately captured outcomes for rapidly growing minority populations, including Asians.
Purpose of the Study:
- To investigate differences in ACS quality of care and in-hospital mortality across racial groups.
- To analyze guideline adherence and outcomes in the context of contemporary treatments.
Main Methods:
- Retrospective analysis of 689,238 ACS hospitalizations (2008-2011) from the Healthcare Cost and Utilization Project database.
- Inclusion of all insurance types, with adjustments for patient demographics, clinical factors, and hospital clustering.
- Comparison of outcomes across white, black, Asian, Hispanic, and Native American patient groups.
Main Results:
- Black patients exhibited the lowest in-hospital mortality (5%) despite lower rates of timely angiography and DES use.
- Asian patients had the highest in-hospital mortality (7%) despite higher rates of timely angiography and the highest DES use (74%).
- Significant variations in mortality and treatment patterns were observed across racial groups, even after statistical adjustments.
Conclusions:
- Asian patients experienced worse in-hospital ACS outcomes despite receiving more guideline-recommended early invasive treatments.
- Black patients demonstrated better in-hospital outcomes despite receiving less guideline-driven care, highlighting complex disparities.
- Racial disparities in ACS care and outcomes persist in the era of advanced therapies.
Abstract:
Guideline adherence and variation in acute coronary syndrome (ACS) outcomes by race in the modern era of drug-eluting stents (DES) are not well understood. Previous studies also fail to capture rapidly growing minority populations, such as Asians. A retrospective analysis of 689,238 hospitalizations for ACS across all insurance types from 2008 to 2011 from the Healthcare Cost and Utilization Project database was performed to determine whether quality of ACS care and mortality differ by race (white, black, Asian, Hispanic, or Native American), with adjustment for patient clinical and demographic characteristics and clustering by hospital. We found that black patients had the lowest in-hospital mortality rates (5% vs 6% to 7% for other races, p <0.0001, odds ratio [OR] 1.02, 95% confidence interval [CI] 0.97 to 1.07), despite low rates of timely angiography in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, and lower use of DES (30% vs 38% to 40% for other races, p <0.0001). In contrast, Asian patients had the highest in-hospital mortality rates (7% vs 5% to 7% for other races, p <0.0001, odds ratio 1.13, 95% CI 1.08 to 1.20, relative to white patients), despite higher rates of timely angiography in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, and the highest use of DES (74% vs 63% to 68% for other races, p <0.0001). Asian patients had the worst in-hospital mortality outcomes after ACS, despite high use of early invasive treatments. Black patients had better in-hospital outcomes despite receiving less guideline-driven care.
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