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Differences in mortality and use of revascularization in black and white patients with acute MI admitted to hospitals with and without revascularization services
Journal article   Open access   Peer reviewed

Differences in mortality and use of revascularization in black and white patients with acute MI admitted to hospitals with and without revascularization services

Ioana Popescu, Mary S Vaughan-Sarrazin and Gary E Rosenthal
JAMA : the journal of the American Medical Association, Vol.297(22), pp.2489-2495
06/13/2007
DOI: 10.1001/jama.297.22.2489
PMID: 17565083
url
https://doi.org/10.1001/jama.297.22.2489View
Published (Version of record) Open Access

Abstract

Racial differences in the use of coronary revascularization after acute myocardial infarction (AMI) have been widely reported. However, few studies have examined patterns of care for AMI patients admitted to hospitals with and without revascularization services. To compare rates of hospital transfer, coronary revascularization, and mortality after AMI for black and white patients admitted to hospitals with and without revascularization services. Retrospective cohort study of 1,215,924 black and white Medicare beneficiaries aged 68 years and older, admitted with AMI between January 1, 2000, and June 30, 2005, to 4627 US hospitals with and without revascularization services. For patients admitted to nonrevascularization hospitals, transfer to another hospital with revascularization services; for all patients, risk-adjusted rates of 30-day coronary revascularization and 1-year mortality. Black patients admitted to hospitals without revascularization were less likely (25.2% vs 31.0%; P<.001) to be transferred. Black patients admitted to hospitals with or without revascularization services were less likely to undergo revascularization than white patients (34.3% vs 50.2% and 18.3% vs 25.9%; P<.001) and had higher 1-year mortality (35.3% vs 30.2% and 39.7% vs 37.6%; P<.001). After adjustment for sociodemographics, comorbidity, and illness severity, blacks remained less likely to be transferred (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.75-0.81; P<.001) and undergo revascularization (HR, 0.71; 95% CI, 0.69-0.74; P<.001; and HR, 0.68; 95% CI, 0.65-0.70; P<.001 in hospitals with and without revascularization, respectively). Risk-adjusted mortality was lower for blacks during the first 30 days after admission (HR, 0.91; 95% CI, 0.88-0.93; P<.001; and HR, 0.90; 95% CI, 0.87-0.92; P<.001 in hospitals with and without revascularization, respectively) but was higher (P<.001) thereafter. Black patients admitted to hospitals with and without coronary revascularization services are less likely to receive coronary revascularization. The higher long-term mortality of black patients may reflect the lower use of revascularization or other aspects of AMI care.
 Myocardial Infarction - mortality United States Humans Proportional Hazards Models European Continental Ancestry Group - statistics & numerical data Male Hospitalization Socioeconomic Factors Myocardial Revascularization - utilization Myocardial Infarction - therapy African Americans - statistics & numerical data Cardiology Service, Hospital - statistics & numerical data Outcome and Process Assessment (Health Care) Delivery of Health Care Hospitals - statistics & numerical data Female Myocardial Revascularization - statistics & numerical data Aged Retrospective Studies Myocardial Infarction - ethnology

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