Fewer Procedures, More Deaths for African-Americans, Study Shows
Reviewed by Louise Chang, MD
June 12, 2007 – After heart attacks, African-Americans get less open-heart surgery and fewer artery-unblocking procedures — and are more likely to die — than whites.
It’s not ancient history. The finding comes from a contemporary analysis of the medical records of more than 1.2 million Medicare patients aged 68 and older. All of the patients had first heart attacks between 2000 and 2005.
Heart attacks happen when blood vessels supplying the heart muscle become blocked, leading to the death of parts of the heart muscle. For some patients, it’s helpful to unblock these arteries — either by bypass surgery or by balloon angioplasty.
These procedures work equally well for people of all races. Yet studies consistently find that African-American heart attack patients are significantly less likely to get these procedures than are white heart attack patients.
A new study led by Ioana Popescu, MD, MPH, of the Iowa City VA Medical Center and the University of Iowa, shows this racial disparity persists.
“Unfortunately, the differences we found were not small,” Popescu tells WebMD.
Popescu and colleagues found that compared with white patients:
- When treated at hospitals that provide angioplasty and bypass surgery, African-American heart attack patients receive these services less often (34% vs. 50%).
- When treated at hospitals that do not provide these specialized heart services, African-American heart attack patients are less likely to be transferred to a hospital that does provide them (25% vs. 31%).
- “Even after transfer to a hospital that provided them, African-American patients were less likely to receive these services,” Popescu says.
- While African-American heart attack patients are less likely to die in the month after their heart attack — possibly due to the short-term risk posed by the procedures — they are more likely to die within a year of their heart attack (37% vs. 33%).
“This study tells us there is a difference in quality of care for heart attack — and it leads to a mortality difference,” Giselle Corbie-Smith, MD, tells WebMD. Corbie-Smith, director of the program on health disparities at the University of North Carolina Sheps Center for Health Services Research, was not involved in the Popescu study.
Popescu is quick to point out that the study does not answer important questions, such as why these disparities exist and what can be done about them.
“We are still uncovering these racial differences so much talked about since the ’90s — and the gap is not closing,” she says. “This is worrisome.”
Corbie-Smith agrees that the study does not explain why disparities exist. But she says it does a great service by pointing them out.
“What I like about this study is it gives another point of discussion for patients to have with their doctors,” she says. “I see it as another opportunity for people to have more open discussions with their doctors.”
Popescu notes that there’s very little opportunity for discussion once a person has a heart attack. But heart attacks rarely come from nowhere. The time to have frank discussions with your doctor, she says, is when patients first become aware that they have heart attack risk factors.
“Your best bet is to ask your doctor as many questions as you can,” she says. “Never be shy of doing that.”
Popescu and colleagues report their findings in the June 13 issue of The Journal of the American Medical Association.
SOURCES: Popescu, I. The Journal of the American Medical Association, June 13, 2007; vol 297: pp 2489-2495. Ioana Popescu, MD, MPH, Iowa City VA Medical Center and University of Iowa Carver College of Medicine, Iowa City. Giselle Corbie-Smith, MD, director, program on health disparities, University of North Carolina Sheps Center for Health Services Research; associate professor of social medicine, medicine, and epidemiology, University of North Carolina, Chapel Hill.
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