This article is more than 5 years old. Information may no longer be current.
Prehospital characteristics confer worse survival rates after acute MI in black patients
Differing clinical and socioeconomic characteristics in black and white patients at the time of hospital admission for acute MI contributed to increased mortality rates for black patients, according to a study published in JAMA Network Open.
“Our findings provide a different perspective to the extensive literature on racial disparities in survival after [acute] MI,” Garth N. Graham, MD, MPH, of the department of cardiovascular research at Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, and colleagues wrote. “There has been a wealth of data on differences in treatment, discharge measures and other quality of care indicators and the contribution of those differences to outcomes between black patients and white patients; however, we primarily focused on prehospital characteristics and showed an almost threefold increase in 5-year mortality risk across the range of attributes associated with being a black individual.”
To investigate how socioeconomic and clinical factors are linked to race — and to what extent these patient characteristics influence survival differences in black and white patients after acute MI — researchers conducted a cohort study using data of 6,402 patients prospectively collected at 31 hospitals across the United States between 2003 and 2008 from two acute MI registries (mean age, 60 years; 33% women; 26% black).
After categorizing patient characteristics into eight domains (demographic characteristics, socioeconomic status, social support, lifestyle factors, medical history, clinical presentation, health status and depressive symptoms), researchers considered the degree to which each domain was separately associated with black patients and white patients, which was done by calculating propensity scores. The final propensity score was then associated with 1- and 5-year mortality rates.
Researchers found that the 5-year mortality rate was 28.9% for black patients and 18% for white patients (HR = 1.72; 95% CI, 1.54-1.92) and that most of the categories of patient characteristics were significantly different between black patients and white patients.
Regardless of whether the patient was of the black or white race, those in the lowest propensity score quintile associated with being a black individual had a 5-year mortality rate of 15.5% and those in the highest quintile had a 5-year mortality rate of 31% (P < .001).
After researchers adjusted for the propensity associated with being a black patient, they found no significant mortality rate difference by race (adjusted HR = 1.09; 95% CI; 0.93-1.26). There was also no statistical interaction between race and propensity score (P = .42).
“Our data suggest that there are myriad characteristics associated with race that likely contribute to racial disparities in [acute] MI outcomes,” the researchers wrote. “More compelling is that those factors were strongly associated with mortality, and this finding should prompt new research into novel treatment strategies that can address novel potential mediators of racial disparities in survival after [acute] MI.” – by Melissa J. Webb
Disclosure: Graham reports he receives fees from Aetna. Please see the study for all other authors’ relevant financial disclosures.