Fifteen‐Year Trends in Management and Outcomes of Non–ST‐Segment–Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000–2014
Background Standardization of evidence‐based medical therapies has improved outcomes for patients with non–ST‐segment–elevation myocardial infarction (NSTEMI). Although racial differences in NSTEMI management have previously been reported, it is uncertain whether these differences have been ameliora...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-10-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.010203 |
| _version_ | 1811332119241162752 |
|---|---|
| author | Sameer Arora George A. Stouffer Anna Kucharska‐Newton Muthiah Vaduganathan Arman Qamar Kunihiro Matsushita Dhaval Kolte Harmony R. Reynolds Sripal Bangalore Wayne D. Rosamond Deepak L. Bhatt Melissa C. Caughey |
| author_facet | Sameer Arora George A. Stouffer Anna Kucharska‐Newton Muthiah Vaduganathan Arman Qamar Kunihiro Matsushita Dhaval Kolte Harmony R. Reynolds Sripal Bangalore Wayne D. Rosamond Deepak L. Bhatt Melissa C. Caughey |
| author_sort | Sameer Arora |
| collection | DOAJ |
| description | Background Standardization of evidence‐based medical therapies has improved outcomes for patients with non–ST‐segment–elevation myocardial infarction (NSTEMI). Although racial differences in NSTEMI management have previously been reported, it is uncertain whether these differences have been ameliorated over time. Methods and Results The ARIC (Atherosclerosis Risk in Communities) Community Surveillance study conducts hospital surveillance of acute myocardial infarction in 4 US communities. NSTEMI was classified by physician review, using a validated algorithm. From 2000 to 2014, 17 755 weighted hospitalizations for NSTEMI (patient race: 36% black, 64% white) were sampled by ARIC. Black patients were younger (aged 60 versus 66 years), more often female (45% versus 38%), and less likely to have medical insurance (88% versus 93%) but had more comorbidities. Black patients were less often administered aspirin (85% versus 92%), other antiplatelet therapy (45% versus 60%), β‐blockers (85% versus 88%), and lipid‐lowering medications (68% versus 76%). After adjustments, black patients had a 24% lower probability of receiving nonaspirin antiplatelets (relative risk: 0.76; 95% confidence interval, 0.71–0.81), a 29% lower probability of angiography (relative risk: 0.71; 95% confidence interval, 0.67–0.76), and a 45% lower probability of revascularization (relative risk: 0.55; 95% confidence interval, 0.50–0.60). No suggestion of a changing trend over time was observed for any NSTEMI therapy (P values for interaction, all >0.20). Conclusions This longitudinal community surveillance of hospitalized NSTEMI patients suggests black patients have more comorbidities and less likelihood of receiving guideline‐based NSTEMI therapies, and these findings persisted across the 15‐year period. Focused efforts to reduce comorbidity burden and to more consistently implement guideline‐directed treatments in this high‐risk population are warranted. |
| first_indexed | 2024-04-13T16:31:04Z |
| format | Article |
| id | doaj.art-02d84ebe0174485199916a8fa8940dd4 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:31:04Z |
| publishDate | 2018-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-02d84ebe0174485199916a8fa8940dd42022-12-22T02:39:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-10-0171910.1161/JAHA.118.010203Fifteen‐Year Trends in Management and Outcomes of Non–ST‐Segment–Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000–2014Sameer Arora0George A. Stouffer1Anna Kucharska‐Newton2Muthiah Vaduganathan3Arman Qamar4Kunihiro Matsushita5Dhaval Kolte6Harmony R. Reynolds7Sripal Bangalore8Wayne D. Rosamond9Deepak L. Bhatt10Melissa C. Caughey11Division of Cardiology University of North Carolina School of Medicine Chapel Hill NCDivision of Cardiology University of North Carolina School of Medicine Chapel Hill NCDepartment of Epidemiology University of North Carolina Gillings School of Global Public Health Chapel Hill NCBrigham and Women's Hospital Heart & Vascular Center and Harvard Medical School Boston MABrigham and Women's Hospital Heart & Vascular Center and Harvard Medical School Boston MADepartment of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MDDivision of Cardiology Warren Alpert Medical School of Brown University Providence RIDivision of Cardiology New York University School of Medicine New York NYDivision of Cardiology New York University School of Medicine New York NYDepartment of Epidemiology University of North Carolina Gillings School of Global Public Health Chapel Hill NCBrigham and Women's Hospital Heart & Vascular Center and Harvard Medical School Boston MADivision of Cardiology University of North Carolina School of Medicine Chapel Hill NCBackground Standardization of evidence‐based medical therapies has improved outcomes for patients with non–ST‐segment–elevation myocardial infarction (NSTEMI). Although racial differences in NSTEMI management have previously been reported, it is uncertain whether these differences have been ameliorated over time. Methods and Results The ARIC (Atherosclerosis Risk in Communities) Community Surveillance study conducts hospital surveillance of acute myocardial infarction in 4 US communities. NSTEMI was classified by physician review, using a validated algorithm. From 2000 to 2014, 17 755 weighted hospitalizations for NSTEMI (patient race: 36% black, 64% white) were sampled by ARIC. Black patients were younger (aged 60 versus 66 years), more often female (45% versus 38%), and less likely to have medical insurance (88% versus 93%) but had more comorbidities. Black patients were less often administered aspirin (85% versus 92%), other antiplatelet therapy (45% versus 60%), β‐blockers (85% versus 88%), and lipid‐lowering medications (68% versus 76%). After adjustments, black patients had a 24% lower probability of receiving nonaspirin antiplatelets (relative risk: 0.76; 95% confidence interval, 0.71–0.81), a 29% lower probability of angiography (relative risk: 0.71; 95% confidence interval, 0.67–0.76), and a 45% lower probability of revascularization (relative risk: 0.55; 95% confidence interval, 0.50–0.60). No suggestion of a changing trend over time was observed for any NSTEMI therapy (P values for interaction, all >0.20). Conclusions This longitudinal community surveillance of hospitalized NSTEMI patients suggests black patients have more comorbidities and less likelihood of receiving guideline‐based NSTEMI therapies, and these findings persisted across the 15‐year period. Focused efforts to reduce comorbidity burden and to more consistently implement guideline‐directed treatments in this high‐risk population are warranted.https://www.ahajournals.org/doi/10.1161/JAHA.118.010203guideline adherencemyocardial infarctionquality of carerace |
| spellingShingle | Sameer Arora George A. Stouffer Anna Kucharska‐Newton Muthiah Vaduganathan Arman Qamar Kunihiro Matsushita Dhaval Kolte Harmony R. Reynolds Sripal Bangalore Wayne D. Rosamond Deepak L. Bhatt Melissa C. Caughey Fifteen‐Year Trends in Management and Outcomes of Non–ST‐Segment–Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000–2014 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease guideline adherence myocardial infarction quality of care race |
| title | Fifteen‐Year Trends in Management and Outcomes of Non–ST‐Segment–Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000–2014 |
| title_full | Fifteen‐Year Trends in Management and Outcomes of Non–ST‐Segment–Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000–2014 |
| title_fullStr | Fifteen‐Year Trends in Management and Outcomes of Non–ST‐Segment–Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000–2014 |
| title_full_unstemmed | Fifteen‐Year Trends in Management and Outcomes of Non–ST‐Segment–Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000–2014 |
| title_short | Fifteen‐Year Trends in Management and Outcomes of Non–ST‐Segment–Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000–2014 |
| title_sort | fifteen year trends in management and outcomes of non st segment elevation myocardial infarction among black and white patients the aric community surveillance study 2000 2014 |
| topic | guideline adherence myocardial infarction quality of care race |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.010203 |
| work_keys_str_mv | AT sameerarora fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 AT georgeastouffer fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 AT annakucharskanewton fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 AT muthiahvaduganathan fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 AT armanqamar fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 AT kunihiromatsushita fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 AT dhavalkolte fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 AT harmonyrreynolds fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 AT sripalbangalore fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 AT waynedrosamond fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 AT deepaklbhatt fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 AT melissaccaughey fifteenyeartrendsinmanagementandoutcomesofnonstsegmentelevationmyocardialinfarctionamongblackandwhitepatientstheariccommunitysurveillancestudy20002014 |