Impact of Race on Cardiac Care and Outcomes in Veterans With Acute Myocardial Infarction

Abstract

Objectives The goal of this study was to assess racial differences in process of care and outcome for acute myocardial infarction in the VA health care system. Design Retrospective cohort study using clinical data. Setting Eighty-one acute care VA hospitals. Patients Four thousand seven hundred sixty veterans discharged with a confirmed diagnosis of acute myocardial infarction. The analysis was restricted to 606 black and 4005 white patients. Main outcome measures Comparison of use of guideline-based medications, invasive cardiac procedures, and all-cause mortality at 30 days, 1 year, and 3 years. Results Black patients were equally likely to receive beta-blockers, more likely than white patients to receive aspirin (86.8% vs. 82.0%; P Conclusions In this integrated health care system, no significant racial disparities in use of noninterventional therapies, diagnostic coronary angiography, or short- or long-term mortality was found. Disparities in use of thrombolytic therapy and coronary artery bypass surgery existed, however, even after accounting for differences in clinical indications for treatment and patient refusals. Further work should assess the role of the medical interaction and physician behavior in racial disparities in use of health care.