Heart attacks have declined, but disparities in treatment, outcomes remain
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Key takeaways:
- Overall, the incidence of heart attacks in the U.S. declined approximately 50% since 2004.
- This reduction was not observed in all subgroups, and gaps in management and intervention persisted.
Despite significant decline in heart attacks since 2004, inequities in STEMI management and mortality by age, gender, income and race, speakers reported.
Two studies, one evaluating trends in STEMI incidence and mortality by age and income and one evaluating gender and racial disparities in non-STEMI management, were presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
Trends in STEMI incidence across the U.S.
Using nationwide inpatient data from 2004 to 2020, Fares Ghanem, MD, cardiovascular disease physician at Southern Illinois University, and colleagues evaluated demographic trends in per-population STEMI hospitalization rates across the U.S. Their analysis included more than 3.4 million patients.
Overall, STEMI incidence decreased from 98.7 per 100,000 hospitalizations per population in 2004 to 49 per 100,000 hospitalizations per population in 2020 (P < .01), according to the presentation.
Among patients aged more than 85 years, mortality decreased from 25% in 2004 to 22% in 2020. Among patients ages 65 to 84 years, mortality decreased from 13% in 2004 to 10.5% in 2020. For patients aged 45 to 65 years, mortality increased slightly from 4% in 2004 to 5.5% in 2020. Mortality among patients aged 18 to 44 years remained unchanged, in the 2.5% to 3% range, according to the presentation.
The incidence of STEMI decreased from 107 per 100,000 population in 2004 to 54 per 100,000 population in 2020 among those with low household income, while incidence decreased from 85 per 100,000 population in 2004 to 42 per 100,000 population in 2020 among those with high household income. However, patients with low household income had elevated risk for mortality compared with those with high household income (adjusted OR = 1.12; 95% CI, 1.1-1.14; P < .01).
“Seeing a decline in STEMI overall was surprising,” Ghanem said in a press release. “However, the disparities uncovered by our study emphasize there is a gap in care. We encourage clinicians to focus on providing equitable access to high-quality care through increased education and implementing targeted interventions for vulnerable populations. Our goal is for our data to be used to help create better, more tailored care plans for patients across the country.”
Inequities in non-STEMI management
In a separate study, Mandvi Devendra Pandey, MD, resident physician at Texas Health Resources, and colleagues evaluated gender and racial disparities in the management of type 1 non-STEMI.
The researchers used National Inpatient Sample data from 2016 to 2020 to identify more than 2.1 million patients who underwent coronary angiography or PCI for non-STEMI.
Pandey and colleagues reported that women with non-STEMI had an approximately 18.4% lower odds of undergoing coronary angiography and/or PCI compared with men with non-STEMI (adjusted OR = 0.816; 95% CI, 0.804-0.828; P < .001).
Compared with white patients with non-STEMI, Black patients (aOR = 0.746; 95% CI, 0.726-0.767; P < .001) and Hispanic patients (aOR = 0.831; 95% CI, 0.806-0.858; P < .001) had significantly lower odds of undergoing coronary angiography and/or PCI, according to the presentation.
“As health care professionals, we are trained to care for all our patients equally regardless of race or gender,” Pandey said in the release. “Yet, our study observed disparities in the interventional management of type 1 non-STEMI patients. It is crucial to address these disparities not only to enhance individual patient outcomes but also to advance health equity and social justice. Our study can serve as a positive catalyst by raising awareness, advocating for targeted quality improvements, and health care system reforms so everyone can have better cardiovascular care.”
References:
- National incidence of heart attacks decline 50% since 2004, yet underrepresented groups remain at highest risk. https://scai.org/national-incidence-heart-attacks-decline-50-2004-yet-underrepresented-groups-remain-highest-risk. Published May 3, 2024. Accessed May 7, 2024.
- Pandey MD, et al. Poster A-64. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 2-4, 2024; Long Beach, California.
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Ghanem F, et al. Abstract OR06-10. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 2-4, 2024; Long Beach, California.
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