Race, socio-economic status: revascularization rate differences persist among women with ACS



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The two-decade study that uses data from the Women's Health Initiative reinforces the need to increase the cultural competence of physicians, said the presenter.

While revascularization rates have increased significantly among postmenopausal women with acute coronary syndrome in the United States, disparities in care between different racial groups have not been reduced, according to a new study.

It is well known that race and Socioeconomic status may affect the outcome of cardiovascular disease, but the precise cause of this disease remains unknown.

"Because different groups have different ways of understanding based on their own experiences, [I think] cultural Understanding is essential for physicians, "said Tarryn Tertulien of Brown University's School of Medicine (Providence, RI) today during a session. 2019 Scientific Sessions of Research on Quality of Care and Outcomes (QCOR) of the American Heart Association (AHA) in Arlington, Virginia, said TCTMD. She also stressed the need for doctors to "[be] aware of their own implicit biases when they see patients arrive with certain symptoms. "

In 2002, the American College of Cardiology and the AHA published an update standard treatment guidelines for patients with unstable angina and NSTEMI. Tertulien and his colleagues examined the revascularization rates of more than 20,000 postmenopausal women – including 17,509 white, 2,181 black and 572 Hispanic – from Women's Health. Initiative before and after 2005.

Overall rates of revascularization increased in the study population between 1993 and 2018. However, black and Hispanic women were generally less likely to be revascularized for ACS or coronary artery disease compared to white women before and after 2005.

Revascularization rate by race, compared to white

Before 2005

After 2005

HOUR

95% CI

HOUR

95% CI

Black

ACS or CHD

0.50

0.45 to 0.57

0.50

0.43-0.58

STEMI

0.85

0.59-1.24

0.61

0.38 to 0.98

NSTEMI

1.08

0.76 to 1.56

0.73

0.54-1.01

Hispanic

ACS or CHD

0.77

0.63 to 0.94

0.93

0.74 to 1.16

STEMI

1.82

0.93 to 3.55

0.92

0.47 to 1.81

NSTEMI

2.36

1.40 to 3.97

1.10

0.69 to 1.74

Abbreviation: CHD, coronary heart disease.

It is interesting to note that there was no difference in revascularization rates among women with low or high socio-economic status during the study period, although women with low socioeconomic status tend to be revascularized less often than their high socio-economic status counterparts after 2005.

Revascularization rate, low or high socioeconomic status

Before 2005

After 2005

HOUR

95% CI

HOUR

95% CI

ACS or CHD

1.02

0.85 to 1.09

0.91

0.83-1.01

STEMI

0.93

0.76 to 1.13

1.02

0.77 to 1.34

NSTEMI

0.83

0.66-1.02

0.92

0.73 to 1.15

Deviations in revascularization rates persisted after accounting for education, income, insurance status and other complications, including diabetes and hypertension, declared Tertulian. These data give no indication as to why this might happen, she added, but "there is a great need to better understand the disparities in cardiovascular risk factors so that clinicians and medical professionals can public health can have greater cultural knowledge. sensitivity in terms of knowing how to solve this problem, in terms of increased education of patients about the symptoms when they experience them, [and] types of services that can be targeted at certain minority groups and communities. "

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