Robin Mathews1, Anita Y Chen1, Laine Thomas1, Tracy Y Wang1, Chee Tang Chin1, Kevin L Thomas1, Matthew T Roe1, Eric D Peterson2. 1. From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.M., A.Y.C., L.T., T.Y.W., K.L.T., M.T.R., E.D.P.); and National Heart Centre Singapore, Singapore (C.T.C.). 2. From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.M., A.Y.C., L.T., T.Y.W., K.L.T., M.T.R., E.D.P.); and National Heart Centre Singapore, Singapore (C.T.C.). Peter016@mc.duke.edu.
Abstract
BACKGROUND: Blacks are less likely than whites to receive coronary revascularization and evidence-based therapies after acute myocardial infarction, yet the impact of these differences on long-term outcomes is unknown. METHODS AND RESULTS: We linked Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of American College of Cardiology/American Heart Association Guidelines (CRUSADE) registry data to national Medicare claims, creating a longitudinal record of care and outcomes among 40 500 patients with non-ST-segment-elevation myocardial infarction treated at 446 hospitals to examine mortality and readmission rates (mean follow-up, 2.4 years) among black and white patients. Relative to whites (n=37 384), blacks (n=3116) were more often younger and female; more often had diabetes mellitus and renal failure; and received less aggressive interventions, including cardiac catheterization (60.7% versus 54.0%; P<0.001), percutaneous coronary intervention (32.1% versus 23.8%; P<0.001), and coronary bypass surgery (9.2% versus 5.7%; P<0.001). Although blacks had lower 30-day mortality (9.1% versus 9.9%; adjusted hazard ratio, 0.80; 95% confidence interval, 0.71-0.92), they had higher observed mortality at 1 year (27.9% versus 24.5%; P<0.001), although this was not significant after adjustment on long-term follow-up (hazard ratio, 1.00; 95% confidence interval, 0.94-1.07). Black patients also had higher 30-day (23.6% versus 20.0%; P<0.001) and 1-year (62.0% versus 54.6%; P<0.001) all-cause readmission, but these differences were no longer significant after risk adjustment on 30-day (hazard ratio, 1.02; 95% confidence interval, 0.92-1.13) and long-term (hazard ratio, 1.05; 95% confidence interval, 1.00-1.11) follow-up. CONCLUSIONS: Although older blacks with an acute myocardial infarction had lower initial mortality rates than whites, this early survival advantage did not persist during long-term follow-up. The reasons for this are multifactorial but may include differences in comorbidities and postdischarge care.
BACKGROUND: Blacks are less likely than whites to receive coronary revascularization and evidence-based therapies after acute myocardial infarction, yet the impact of these differences on long-term outcomes is unknown. METHODS AND RESULTS: We linked Can Rapid Risk Stratification of Unstable AnginaPatients Suppress Adverse Outcomes With Early Implementation of American College of Cardiology/American Heart Association Guidelines (CRUSADE) registry data to national Medicare claims, creating a longitudinal record of care and outcomes among 40 500 patients with non-ST-segment-elevation myocardial infarction treated at 446 hospitals to examine mortality and readmission rates (mean follow-up, 2.4 years) among black and whitepatients. Relative to whites (n=37 384), blacks (n=3116) were more often younger and female; more often had diabetes mellitus and renal failure; and received less aggressive interventions, including cardiac catheterization (60.7% versus 54.0%; P<0.001), percutaneous coronary intervention (32.1% versus 23.8%; P<0.001), and coronary bypass surgery (9.2% versus 5.7%; P<0.001). Although blacks had lower 30-day mortality (9.1% versus 9.9%; adjusted hazard ratio, 0.80; 95% confidence interval, 0.71-0.92), they had higher observed mortality at 1 year (27.9% versus 24.5%; P<0.001), although this was not significant after adjustment on long-term follow-up (hazard ratio, 1.00; 95% confidence interval, 0.94-1.07). Black patients also had higher 30-day (23.6% versus 20.0%; P<0.001) and 1-year (62.0% versus 54.6%; P<0.001) all-cause readmission, but these differences were no longer significant after risk adjustment on 30-day (hazard ratio, 1.02; 95% confidence interval, 0.92-1.13) and long-term (hazard ratio, 1.05; 95% confidence interval, 1.00-1.11) follow-up. CONCLUSIONS: Although older blacks with an acute myocardial infarction had lower initial mortality rates than whites, this early survival advantage did not persist during long-term follow-up. The reasons for this are multifactorial but may include differences in comorbidities and postdischarge care.
Authors: Chester K Yarbrough; Paul G Gamble; Muhammad Burhan Janjua; Mengxuan Tang; Rahel Ghenbot; Andrew J Zhang; Neringa Juknis; Ammar H Hawasli; Michael P Kelly; Wilson Z Ray Journal: J Neurosurg Sci Date: 2016-05-06 Impact factor: 2.279
Authors: Lisandro D Colantonio; Keri L Monda; Robert S Rosenson; Todd M Brown; Katherine E Mues; George Howard; Monika M Safford; Larisa Yedigarova; Michael E Farkouh; Paul Muntner Journal: Cardiovasc Drugs Ther Date: 2019-04 Impact factor: 3.727
Authors: Taisei Kobayashi; Thomas J Glorioso; Ehrin J Armstrong; Thomas M Maddox; Mary E Plomondon; Gary K Grunwald; Steven M Bradley; Thomas T Tsai; Stephen W Waldo; Sunil V Rao; Subhash Banerjee; Brahmajee K Nallamothu; Deepak L Bhatt; A Garvey Rene; Robert L Wilensky; Peter W Groeneveld; Jay Giri Journal: JAMA Cardiol Date: 2017-09-01 Impact factor: 14.676
Authors: Lisandro D Colantonio; Christopher M Gamboa; Joshua S Richman; Emily B Levitan; Elsayed Z Soliman; George Howard; Monika M Safford Journal: Circulation Date: 2017-07-11 Impact factor: 29.690
Authors: J Walker Blackston; Monika M Safford; Matthew T Mefford; Elizabeth Freeze; George Howard; Virginia J Howard; David C Naftel; Todd M Brown; Emily B Levitan Journal: Circ Cardiovasc Qual Outcomes Date: 2020-12-11
Authors: Robert J Goldberg; Joel M Gore; David D McManus; Richard McManus; Mayra Tisminetzky; Darleen Lessard; Jerry H Gurwitz; David C Parish; Jeroan Allison; Connie Ng Hess; Tracy Wang; Catarina Kiefe Journal: Prev Med Rep Date: 2017-01-24