06:00am Wednesday 23 October 2019

Care for Asian-American heart attack patients improves, comparable to whites in Get With The Guidelines hospitals

DALLAS ― Care for Asian-American heart attack patients treated in hospitals in the American Heart Association’s Get With The Guidelines ®-Coronary Artery Disease program improved between 2003-08 and, with few exceptions, is comparable to care for whites. The research is reported in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.
The findings are similar to other studies on blacks and Hispanics that found participation in the Get With The Guidelines quality improvement program reduced care gaps due to racial and ethnic disparities.
“Equitable quality care is possible across racial and ethnic groups, through quality improvement programs such as Get With The Guidelines,” said Feng Qian, M.D., Ph.D., the study’s lead author and a research assistant professor in the Department of Anesthesiology at the University of Rochester Medical Center in New York. “This improved care is more significant and sustainable the longer hospitals participate in the program.”
Qian said Asian-Americans represent an important minority population and are one of the fastest growing racial/ethnic groups in the United States. However, very little was previously known about the clinical experience and outcomes of Asian-American heart attack patients.
Researchers analyzed data on 107,403 Asian-American and white heart attack patients from the Get With The Guidelines–Coronary Artery Disease database. Asian-Americans accounted for 4.1 percent of the patients in the study who were treated at 382 hospitals from 2003-08.
Care for Asian-Americans and whites improved in all measures over the five years. Only three measures were significantly different between the groups:
  • Asian-Americans were less likely than whites to receive aspirin after discharge (93.9 percent vs. 96.9 percent)
  • Asian-Americans were less likely than whites to receive smoking cessation counseling (83.1 percent vs. 93.1 percent).
  • Asian-Americans were more likely than whites to receive lipid-lowering therapy (90.5 percent vs.89.3 percent).
Measures of care include:
  • Prescribing aspirin within 24 hours of arrival
  • Prescribing aspirin at discharge
  • Prescribing ACE inhibitors or ARBs at discharge to relax and open arteries to lower blood pressure
  • Prescribing beta blockers at discharge to reduce the heart’s rate and workload to lower blood pressure
  • Offering smoking cessation counseling
  • Prescribing lipid-lowering therapy
  • Improving door-to-balloon time to opening up clogged heart arteries
Asian-Americans were also more likely than whites to die in the hospital after a heart attack (11.5 percent vs. 5.8 percent), though that may partly be the result of patient characteristics rather than the quality of care received, researchers said.
Compared to whites, Asian-American patients were significantly older (average age 71 for Asian-Americans, 67 for whites) and were more likely to have cardiovascular risk factors and conditions including diabetes, hypertension, heart failure and smoking. After adjusting for these, the difference in death rates was reduced but still present.
Some differences in treatment could be due to language barriers, different ways of communicating with healthcare providers or differences in health-seeking behavior influenced by culture, Qian said.
“Health disparities are a serious public health concern in the United States and we’ve seen that different racial and ethnic groups often receive unequal treatment for the same diagnosis,” Qian said. “For that reason, different ethnic and racial groups may have different outcomes. Future studies should look more specifically at differences in care among racial subgroups as well as at more long-term outcomes.”
Co-authors are Frederick S. Ling, M.D.; Prakash Deedwania, M.D.; Adrian F. Hernandez, M.D., M.H.S.; Gregg C. Fonarow, M.D.; Christopher P. Cannon, M.D.; Eric D. Peterson, M.D., M.P.H.; W. Frank Peacock, M.D.; Lisa A. Kaltenbach, M.S.; Warren K. Laskey, M.D.; Lee H. Schwamm, M.D.; and Deepak L. Bhatt, M.D., M.P.H. Author disclosures are on the manuscript.
The Get With The Guidelines®–Coronary Artery Disease (GWTG-CAD) program was provided by the American Heart Association. The GWTG-CAD program was supported in part through the American Heart Association Pharmaceutical Roundtable and an unrestricted educational grant from Merck.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding External link.
NR12–1188 (CircQ&O/Qian)
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