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.

TitleFifteen-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.
Publication TypeJournal Article
Year of Publication2018
AuthorsArora S, Stouffer GA, Kucharska-Newton A, Vaduganathan M, Qamar A, Matsushita K, Kolte D, Reynolds HR, Bangalore S, Rosamond WD, Bhatt DL, Caughey MC
JournalJ Am Heart Assoc
Volume7
Issue19
Paginatione010203
Date Published2018 10 02
ISSN2047-9980
KeywordsAdult, African Americans, Aged, Aged, 80 and over, Disease Management, Electrocardiography, European Continental Ancestry Group, Female, Follow-Up Studies, Forecasting, Hospitalization, Humans, Male, Middle Aged, Morbidity, Non-ST Elevated Myocardial Infarction, Population Surveillance, Retrospective Studies, Survival Rate, Treatment Outcome, United States
Abstract

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.

DOI10.1161/JAHA.118.010203
Alternate JournalJ Am Heart Assoc
PubMed ID30371336
PubMed Central IDPMC6404893