Black, female, and poor elderly patients with acute myocardial infarction were less likely to receive indicated medical therapies, such as reperfusion for black patients (RR 0.84; 95% CI 0.78-0.91).
Observational (n=169,079)
Effect estimate: RR 0.84 (95% CI 0.78-0.91)
BACKGROUND: Race, sex, and poverty are associated with the use of diagnostic cardiac catheterization and coronary revascularization during treatment of acute myocardial infarction (AMI). However, the association of sociodemographic characteristics with the use of less costly, more readily available medical therapies remains poorly characterized. METHODS AND RESULTS: We evaluated 169 079 Medicare beneficiaries >/=65 years of age treated for AMI between January 1994 and February 1996 to determine the association of patient race, sex, and poverty with the use of medical therapy. Multivariable regression models were constructed to evaluate the unadjusted and adjusted influence of sociodemographic characteristics on the use of 2 admission (aspirin, reperfusion) and 2 discharge therapies (aspirin, beta-blockers) indicated during the treatment of AMI. Therapy use varied by patient race, sex, and poverty status. Black patients were less likely to undergo reperfusion (RR 0.84, 95% CI 0. 78, 0.91) or receive aspirin on admission (RR 0.97, 95% CI 0.96, 0. 99) and beta-blockers (RR 0.94, 95% CI 0.88, 1.00) at discharge. Female patients were less likely to receive aspirin on admission (RR 0.98, 95% CI 0.97, 0.99) and discharge (RR 0.98, 95% CI 0.96, 0.99). Poor patients were less likely to receive aspirin (RR 0.97, 95% CI 0. 96, 0.98) or reperfusion (RR 0.97, 95% CI 0.93, 1.00) on admission and aspirin (RR 0.98, 95% CI 0.96, 1.00), or beta-blockers (RR 0.95, 95% CI 0.91, 0.99) on discharge. CONCLUSIONS: Medical therapies are currently underused in the treatment of black, female, and poor patients with AMI.
Rathore et al. (Tue,) conducted a observational in Acute Myocardial Infarction (n=169,079). Black race, female sex, and poverty vs. Non-black, male, and non-poor patients was evaluated on Use of 2 admission (aspirin, reperfusion) and 2 discharge therapies (aspirin, beta-blockers) (RR 0.84, 95% CI 0.78-0.91). Black, female, and poor elderly patients with acute myocardial infarction were less likely to receive indicated medical therapies, such as reperfusion for black patients (RR 0.84; 95% CI 0.78-0.91).