Update on quality of care in Hispanics and other racial-ethnic groups in the United States discharged with the diagnosis of Acute Myocardial Infarction in 2013

• Published in: International journal of cardiology Vol. 248; pp. 28 - 33
• Main Authors: Romero, Tomás, Greenwood, Kristina L., Glaser, Dale
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2017
• Subjects: Aged; Aged, 80 and over; Continental Population Groups - ethnology; Ethnic Groups; European Continental Ancestry Group - ethnology; Female; Healthcare Disparities - ethnology; Healthcare Disparities - standards; Hispanic; Hispanic Americans; Humans; Male; Middle Aged; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - ethnology; Myocardial Infarction - therapy; Outcomes; Patient Discharge - standards; Quality of care; Quality of Health Care - standards; Race-ethnicity; Retrospective Studies; United States - ethnology; Myocardial infarction; Race-ethnicity; Hispanic; Quality of care; Outcomes
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.07.004

Disparities in Acute Myocardial Infarction (AMI) care and outcomes have been frequently reported in racial-ethnic minorities in the U.S. Some studies have attributed disparities in Hispanics and other minorities to lower quality of services at hospitals where they seek care. Current information from hospitals with large Hispanic representations and updated quality resources is needed. Retrospective observational study of 839 AMI patients discharged in 2013 from three Southern California Hospitals (A, B, C) with tertiary cardiac care level. Non-Hispanic Whites (NHW) and Hispanics (H) were the larger racial-ethnic groups (68.3%), and the comparison of these two groups constitutes the focus of the study. Mortality, 30day readmissions, medication/performance measures (PRx); aspirin, statins/anti-lipids, beta-blockers, ACEI/ARB for LV systolic dysfunction, <90min door-balloon time, and revascularization procedures were compared between hospitals, NHW and H, using Chi-squared tests (χ2), Odds Ratios (OR) with 95% confidence intervals (CI), and Z tests for proportions — independent groups. No significant differences in hospital, 30day mortality, PRx or procedures were observed between NHW, H and other racial-ethnic minority groups, or hospitals. Hospital C had 47.3% H and Hospitals A+B 14.6% (p<0.001, effect size=0.430). AMI performance measures exceeded 2013 national rates across all facilities. NHW had more private/commercial insurance (52.5% vs. 25.4%, OR 3.24, 95% CI 2.19–4.80, p<0.001) than H. Equitable access to quality hospital services in three Southern California hospitals offset previously reported disparities in AMI management in Hispanics. These results may not necessarily reflect the reality of AMI care for Hispanics in other U.S. regions.