In the US, over the past 30 years, advances in cardiovascular care have resulted in a dramatic decline in mortality and morbidity associated with ST elevation myocardial infarction (STEMI) and non-STEMI.1,2 The overall incidence of coronary heart disease (CHD) has decreased over the last four decades.3
There are various reports about disparities in healthcare and the higher mortality among African Americans in CHD.3-5 There are few reports looking at racial disparities in the treatment of STEMI. We present our community-based experience demonstrating the disparities among African Americans and Caucasians in the treatment of STEMI.
Hypothesis
The study was designed to test the hypothesis that there is a disparity in the treatment of STEMI among African Americans and Caucasians.
Methods and Design
A retrospective chart review on two STEMI population groups was performed - October 1995 to July 1997 (first) and October 2005 to July 2007 (second). Each of the two groups comprised patients with first event of STEMI in an 18-month timeframe at our community teaching hospital, St. Joseph Mercy Oakland, Pontiac, Michigan, US. The institutional Review Board approved this retrospective review protocol. Data collection included patient demographics, insurance status, co-morbidities, hospital length of stay (LOS) and their clinical outcome with complications if any.
Based on the risk for CHD at different age for men and women, and recommendations for treatment for dyslipidaemia from the Adult Treatment Panel (ATP) III report,6 young population in our study was defined as: males <45 years of age and females <55 years of age. In the second group, population was characterised as obese if their body mass index (BMI) was greater than or equal to 30 kilograms/ square metres (kg/m2). Tobacco use was defined as any patient who had secondary diagnoses of history of tobacco use and/or tobacco use disorder.
Racial disparities between African Americans and Caucasians were measured using their hospital mortality and LOS in the two population groups and re-intervention rate in the second group. Mortality was defined as any STEMI patient who was brought to the hospital and who died during the hospital stay either with or without invasive treatment. In the second group, re-intervention rate was calculated by review of follow-up heart catheterisation reports, if performed. In this group, all patient charts were retrieved for a minimum follow-up period of one year (until July 2008) in order to determine rate of re-intervention procedures. The other details relevant to the methods and statistical tests used can be found in our previously published report from this investigation.7