August 17, 2005

Disparities in heart attack care persist in US

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Numerous reports have described
racial and gender differences in the treatment and outcome of
heart attack patients, and now, new research indicates that not
much as changed in recent years. Black women remain less likely
than other groups to receive a variety of therapies for heart
attack and they are more likely to die in the hospital.

"We were really surprised by the findings," lead author Dr.
Viola Vaccarino, from Emory University in Atlanta, told Reuters
Health. "Due to increased awareness of the problem, we were
expecting differences in treatment by race and gender to
decrease over time."

The findings, which appear in The New England Journal of
Medicine for August 18, are based on an analysis of data from
nearly 600,000 patients who were hospitalized for a heart
attack between 1994 and 2002.

White women, black men, and black women were 3 percent, 9
percent, and 11 percent less likely, respectively, to receive
clot-busting therapy than white men. A similar finding was
observed for coronary angiography with corresponding figures of
9 percent, 18 percent, and 24 percent. By contrast, no
significant racial or gender differences were seen for aspirin
or beta-blocker use.

White women and black men had an in-hospital death rate
that was comparable to white men. Black women, however, were 11
percent more likely than white men to die while hospitalized.

As noted, neither the treatment differences, nor the
mortality findings changed significantly over time.

Better monitoring of hospital performance -- especially
those that primarily serve minority populations -- "may help
decrease the gender and racial differences seen," Vaccarino
said. Making sure these hospitals have the resources they need
to provide the best care possible is important as is finding
ways to improve overall access to care for the economically
disadvantaged groups, the researcher added.

In a related editorial, Dr. Nicole Lurie, from RAND Corp.
in Arlington, Virginia, comments that the enduring trends noted
in the present study "suggest that the adage 'The system is
perfectly designed to get the results that it does' is once
again applicable here."

Thus, she adds, "We will not make progress in eliminating
disparities simply by tinkering with the system."

SOURCE: The New England Journal of Medicine, August 18,