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Association Between Ambulatory Care Utilization and Coronary Artery Disease Outcomes by Race/Ethnicity
Eun Ji Kim1, Victoria A Parker2, Jane M Liebschutz3
1Division of General Internal Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Lake Success NY.
Insights
Lower ambulatory care use and fewer cardiac tests are linked to higher inpatient mortality for acute myocardial infarction (AMI). Minority groups, particularly Asians, face higher AMI mortality risks, highlighting care disparities.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Health Disparities
Background:
- Coronary artery disease (CAD) is a prevalent condition with documented disparities in management and patient outcomes.
- Understanding factors influencing CAD outcomes, especially among diverse populations, is critical for improving cardiovascular care.
Purpose of the Study:
- To investigate the association between ambulatory care utilization and inpatient mortality following acute myocardial infarction (AMI).
- To explore potential disparities in ambulatory care access and their impact on AMI outcomes among different racial and ethnic groups.
Main Methods:
- Retrospective analysis of Medicare fee-for-service enrollees aged 66 years and older (2010-2011).
- Measured ambulatory visit frequency and the presence of outpatient cardiac testing.
- Utilized multivariate logistic regression to assess the relationship between ambulatory care and inpatient AMI mortality, adjusting for demographic, geographic, and clinical factors.
Main Results:
- Minority groups, including Hispanics and Asians, showed lower rates of frequent ambulatory care visits compared to Whites.
- Asians exhibited the highest inpatient mortality rate (15.9%) among major racial/ethnic groups.
- Low ambulatory care utilization was associated with increased odds of inpatient AMI mortality (OR=1.85), while ambulatory cardiac testing was linked to decreased odds (OR=0.73).
- Asians consistently had higher odds of inpatient AMI mortality, even after covariate adjustment.
Conclusions:
- Significant disparities exist in ambulatory care utilization among Medicare beneficiaries, with lower rates observed in Hispanic and Asian populations.
- Both the frequency of ambulatory clinic visits and the performance of outpatient cardiac tests are associated with inpatient AMI mortality.
- Further research is warranted to elucidate the causal pathways linking ambulatory care utilization to cardiovascular outcomes and to address observed health disparities.
Abstract:
Background Coronary artery disease is common, and there exist disparities in management and outcomes. The purpose of this study is to examine the association between ambulatory care utilizations and inpatient acute myocardial infarction (AMI) mortality. Methods and Results This is a retrospective analysis of a stratified national sample of Medicare fee-for-service enrollees aged 66 years and older from January 1, 2010 to December 31, 2011. We measured both number of ambulatory visits and presence of ambulatory cardiac tests. The primary outcome was inpatient AMI mortality. Using multivariate logistic regression models, we estimated the association between ambulatory care utilization and the main patient outcomes, adjusting for patient- and area-level demographic, geographical, and clinical characteristics. We found that a significantly lower percentage of Hispanics and Asians, relative to whites, had frequent ambulatory care visits. Among the largest 4 race/ethnic groups, Asians had the highest observed inpatient mortality rate (15.9%). Overall, low ambulatory utilization was associated with higher odds (odds ratio=1.85 [95% confidence interval: 1.11-3.08]), and ambulatory cardiac testing was associated with lower odds (odds ratio=0.73 [0.55-0.95]) of inpatient AMI mortality, after adjustment for covariates. Asians had higher odds of inpatient AMI mortality even after adjustment for covariates. Conclusions Among Medicare fee-for-service enrollees, Hispanics and Asians had lower rates of ambulatory care visits, and all minority groups had higher odds of hospitalization for AMI. Ambulatory care utilization, including both ambulatory clinic visits and outpatient cardiac tests, were associated with AMI mortality. Further research is needed to understand the causal relationship between ambulatory care utilization and cardiovascular outcomes.
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