Background Many reports in the literature have found the use of invasive cardiac procedures in black patients to be less common than in white patients. These reports tend to have small numbers of black patients compar...
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Background Many reports in the literature have found the use of invasive cardiac procedures in black patients to be less common than in white patients. These reports tend to have small numbers of black patients compared with white patients or rely on the information contained in claims or administrative data. Methods and Results Cardiac catheterization reports were reviewed in a Veterans Administration hospital that serves a large number of black patients. After review of the medical histories and hemodynamic and angiographic findings in 726 black and 734 white male veterans, data were collected to determine recommended and actual therapy. Death was assessed after a 4- to 10-year follow-vp period. White patients were more likely to have significant coronary artery lesions than black patients. Multivariate analysis showed that the likelihood of patients actually having percutaneous transluminal coronary angioplasty or coronary artery bypass surgery did not differ by ethnicity when controlling for disease extent or severity. Coronary artery bypass surgery was associated with decreased mortality rates for both black and white patients. Although short-term death in blacks was not different from whites, blacks had an increased long-term risk for death. Conclusions After coronary angiography, black veterans and white veterans appear to undergo revascularization procedures related to the severity of disease. The decreased long-term life expectancy of black men as compared with whites is not necessarily explained by the presence of or treatment for coronary artery disease in this population.
Background Clinical improvement after transmyocardial laser revascularization (TMR) is typically delayed, and patients therefore remain at risk for ischemic events after the procedure. The purpose of this study was to...
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Background Clinical improvement after transmyocardial laser revascularization (TMR) is typically delayed, and patients therefore remain at risk for ischemic events after the procedure. The purpose of this study was to define the range of creatine phosphokinase (CPK) and CPK-MB enzyme elevation after TMR and to assess the incidence of early postoperative ischemic events. Methods Twenty-one patients undergoing isolated TMR were evaluated For 48 hours after surgery with serial CPK and CPK-MB enzymes and 12-lead electrocardiograms for evidence of myocardial ischemia or injury. Clinically evident postoperative ischemic events including angina pectoris, myocardial infarction (MI), and cardiac death were recorded as well. Results Eleven patients (52.4%) had ischemic electrocardiographic changes in the first 48 hours after TMR. Ischemia was clinically silent in 7 (63.6%) of these 11 patients. Cardiac death occurred in 1 patient (4.8%) as a result of acute MI. Nonfatal MI occurred in an additional 4 patients (19.0%). Of the 5 patients with MI, 4 had angina pectoris versus no angina in the 16 patients without MI (P = .02). All patients had elevated CPK and CPK-MB levels after TMR: however, peak CPK (P = .02) and CPK-MB (P = .005) levels were significantly higher for patients suffering postoperative MI compared with those without MI. Conclusions Transient ischemia occurs frequently after TMR and is clinically silent in the majority of patients. Patients with postoperative MI are more likely to have symptomatic ischemia as well as significant cardiac enzyme elevation. The combination of 12-lead electrocardiogram and cardiac enzymes appears to have significant merit for the diagnosis of myocardial ischemia and infarction after TMR. These studies should be obtained in all patients undergoing TMR for the first 48 hours after surgery.
In 1984, Oberman and Cutter1 reported that black cardiac patients treated at the University of Alabama were less likely to undergo cardiac catheterization or bypass surgery than their white counterparts. That same yea...
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In 1984, Oberman and Cutter1 reported that black cardiac patients treated at the University of Alabama were less likely to undergo cardiac catheterization or bypass surgery than their white counterparts. That same year, Haywood2 found that blacks enrolled in a large -blocker trial had higher long-term mortality rates than whites. Over the ensuing 15 years, dozens of papers have confirmed that racial differences in cardiac care are nearly ubiquitous in the US healthcare system.1,3-23 Similarly, most,4,24 but not all,25 subsequent studies have found that blacks with coronary disease generally have lower long-term survival rates than whites.
Although numerous studies have documented race and sex differences in the treatment of coronary artery disease, the available analyses have not been comprehensively evaluated. In this review, we summarize prior estima...
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Although numerous studies have documented race and sex differences in the treatment of coronary artery disease, the available analyses have not been comprehensively evaluated. In this review, we summarize prior estimates of race and sex disparities in the utilization of standard tests and therapies, and we evaluate studies of factors that may contribute to gaps in care. The studies presented consistently demonstrate that blacks and women with coronary artery disease, compared with whites and men, are substantially less likely to receive standard interventions. Studies also indicate that racial differences relate in part to socioeconomic Factors, process-of-care variables, and patient preferences, whereas sex differences relate in part to clinical factors. In both cases, however, our understanding is limited by deficiencies in currently available datasets. Moreover, factors that have been shown to contribute to race and sex disparities in medical care fail to explain them fully. In both cases, physician decisionmaking appears to contribute as well, suggesting that subconscious biases may contribute to treatment disparities. We conclude by proposing initiatives to remedy race and sex disparities in medical care. Efforts should focus on increasing physician aware ness of this problem. Studies should gather data that are currently unavailable for analysis, including detailed clinical variables and patient-level socioeconomic information. Finally, novel quality assurance programs, designed to evaluate and improve the care of blacks and women with coronary artery disease, should be promptly undertaken.
OBJECTIVES We sought to determine whether men and women are equally likely to receive coronary angiography and revascularization after acute myocardial infarction (AMI) when they are risk stratified according to Ameri...
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OBJECTIVES We sought to determine whether men and women are equally likely to receive coronary angiography and revascularization after acute myocardial infarction (AMI) when they are risk stratified according to American College of Cardiology/American Heart Association (ACC/ AHA) practice guidelines for post-MI care. BACKGROUND Several previous studies have suggested that women may undergo angiography and revascularization procedures less frequently than men. METHODS In 439 consecutive patients admitted to a public hospital with AMI, rates of coronary angiography and revascularization were compared in men and women categorized, according to ACC/AHA. practice guidelines, as having strong (class I or IIa) or weaker (class IIb) indications for angiography. RESULTS Women were older and more likely to be diabetic or hypertensive, but men and women were equally likely to meet class Ima criteria for post-MI angiography (both 51%). Angiography rates were nearly identical in men and women overall (63% vs. 64%), as well as in patients in class I/IIa (80% vs. 82%) and class IIb (46% vs. 46%) (all p > 0.80, with >80% power to detect important differences);the only multivariate predictors of post-MI angiography were age and ACC/AHA class. Significant coronary artery disease was equally prevalent in men and women undergoing angiography, and men and women were equally likely to undergo revascularization, whether they were In class I/IIa (both 55%, p = 0.90) or class IIb (59% vs. 58%, p = 0.88). No significant differences in mortality were noted between men and women. CONCLUSIONS Despite being older and having more risk factors than men, women were equally likely to undergo coronary angiography and revascularization procedures after AMI, and they had in-hospital clinical outcomes that were at least as favorable. (C) 2000 by the American College of Cardiology.
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