There’s a racial gap in NSTEMI care—and it’s not improving
Despite having the highest burden of cardiovascular disease in the U.S. and averaging more comorbidities than white patients, blacks are less likely to receive guideline-concordant care after a non-ST-segment elevation myocardial infarction (NSTEMI), researchers reported this week.
Fifteen-year results of the ARIC Community Surveillance Study, published Sept. 20 in the Journal of the American Heart Association, found black NSTEMI patients received fewer preventive therapies, beta-blockers and lipid-lowering medications than their white counterparts, in spite of the former group’s sizable burden of CVD.
The high prevalence of cardiovascular disease in black patients has been attributed to a similarly high predisposition for diabetes mellitus, hypertension, obesity and dyslipidemia in the population, as well as a host of socioeconomic factors, like geographical and financial barriers to care, corresponding author Melissa C. Caughey, PhD, and colleagues wrote in JAHA. But it’s also important to study how race can play into the treatment of specific acute diseases, like NSTEMI.
“Unlike STEMI, which is primarily managed by protocol-driven strategies, management of NSTEMI may depend more heavily on the treating physician or health system,” Caughey, of the Division of Cardiology at the University of North Carolina in Chapel Hill, and co-authors said. “Previous studies suggest lower utilization of invasive procedures in black patients and racial differences in medical management of NSTEMI.”
Caughey et al. said they weren’t looking to confirm those differences with their research—that’s already been done—but they wanted to assess whether racial disparities had shifted over time.
Using data from 17,755 weighted hospitalizations for NSTEMI patients recorded between 2000 and 2014, the authors compared treatment in black and white patients across four American communities. For the purposes of the study, NSTEMI was diagnosed by a physician using a previously validated algorithm.
Of the study population, which was 36 percent black and 64 percent white, black patients tended to be younger and more often female, Caughey and colleagues reported. Black patients, on average, had more comorbidities, and they were 5 percent less likely than whites to have medical insurance.
Blacks also had a 29 percent lower probability of angiography, 24 percent lower probability of receiving nonaspirin antiplatelets, 45 percent lower probability of revascularization and were less likely to be given lipid-lowering medications (68 percent versus 76 percent). A similar proportion of white and black patients received beta-blockers, though that number was 3 percent lower in blacks.
Caughey and her team said post-discharge mortality was comparable between races, but, despite the standardization and spread of evidence-based therapies for NSTEMI over the study period, gaps in care persisted.
The authors wrote the reasons for those differences are “likely multifactorial,” but probably include black patients more often living in areas with lower access to quality care.
“Recent reports suggest the burden of cardiovascular disease may be ameliorated by improving socioeconomic status in black communities,” they said. “In addition, ample evidence suggests that population-based strategies to influence health behavior may improve cardiovascular risk in the black population.”
They wrote strategies should include a population approach to improve physical activity, dietary habits and tobacco use.
“Despite measures to standardize NSTEMI care, differences have persisted between black and white patients during this time interval,” Caughey et al. said. “Overall reduction in comorbidity burden and consistent implementation of guideline-directed strategies are crucial to mitigate racial disparities in NSTEMI management.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.