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Myocardial infarction classification and its implications on measures of cardiovascular outcomes, quality, and
Aaron L Hilliard1, David E Winchester2,3, Tanya D Russell4
1College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, Florida, USA.
Insights
Heart disease, particularly myocardial infarction (MI), affects African Americans and women disproportionately, leading to higher mortality rates. Addressing diagnostic challenges and health disparities is crucial for improving cardiovascular care outcomes.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Heart disease remains the leading cause of death in the US, with significant racial/ethnic and gender disparities in myocardial infarction (MI) diagnoses and outcomes.
- Current diagnostic codes offer an improved framework, yet clinically differentiating MI types presents ongoing challenges.
- MI misdiagnoses and existing health disparities contribute to adverse outcomes in cardiovascular medicine.
Purpose of the Study:
- To review literature on MI classification and disparities in cardiovascular care and outcomes.
- To highlight the impact of race and sex on MI mortality, comorbidities, and treatment.
- To inform the implementation of new diagnostic assays and quality improvement strategies.
Main Methods:
- Literature review of relevant biomedical sources.
- Analysis of studies focusing on MI classification, diagnosis, and disparities.
- Examination of data concerning race, sex, comorbidities, and treatment in MI patients.
Main Results:
- African Americans and women experience higher MI mortality rates, often present younger with comorbidities, and are less likely to receive novel therapies.
- Differences in race and sex have been observed in the reference ranges and diagnostic thresholds of high-sensitivity troponin assays.
- Health disparities significantly complicate cardiovascular outcomes.
Conclusions:
- Implementation of high-sensitivity troponin assays in the US must consider race and sex differences.
- Further research is essential to understand the complex contribution of health disparities to adverse cardiovascular outcomes.
- Dedicated quality improvement teams and models can potentially improve MI diagnosis, reduce misdiagnosis-related costs, and mitigate cardiovascular health disparities.
Abstract:
Heart disease continues to be the leading cause of death in the United States, with approximately 805 000 cumulative deaths from myocardial infarctions (MI) from 2005 to 2014. Gender and racial/ethnic disparities in MI diagnoses are becoming more evident in quality review audits. Although recent changes in diagnostic codes provided an improved framework, clinically distinguishing types of MI remains a challenge. MI misdiagnoses and health disparities contribute to adverse outcomes in cardiac medicine. We conducted a literature review of relevant biomedical sources related to the classification of MI and disparities in cardiovascular care and outcomes. From the studies analyzed, African Americans and women have higher rates of mortality from MI, are more probably to be younger and present with other comorbidities and are less probably to receive novel therapies with respect to type of MI. As high-sensitivity troponin assays are adopted in the United States, implementation should account for how race and sex differences have been demonstrated in the reference range and diagnostic threshold of the newer assays. More research is needed to assess how the complexity of health disparities contributes to adverse cardiovascular outcomes. Creating dedicated medical quality teams (physicians, nurses, clinical documentation improvement specialists, and medical coders) and incorporating a plan-do-check-adjust quality improvement model are strategies that could potentially help better define and diagnose MI, reduce financial burdens due to MI misdiagnoses, reduce cardiovascular-related health disparities, and ultimately improve and save lives.
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