Heart Attack Death Rates Found Higher for All Patients in Hospitals
Heart Attack Rates
Ninety days after acute myocardial infarction (AMI), or heart attack, death rates for African Americans and white patients were found to be significantly higher in hospitals that disproportionately serve African-American patients than in hospitals that serve mainly white patients, according to a major new study led by researchers at Dartmouth Medical School. The researchers suggest that quality of care, more than racial differences per se, determines AMI outcomes.
Based on the study findings, the investigators assert that targeted quality improvements at hospitals serving large shares of African Americans could enhance AMI care for all patients in those hospitals as well as potentially reduce black-white differences in AMI outcomes overall.
The analysis, published in the October 25, 2005, edition of Circulation: Journal of the American Heart Association, is one of the first to look at the association between the racial composition of a hospital's patients and health outcomes. The study was funded in part by the National Institute on Aging (NIA), a component of the National Institutes of Health, U.S. Department of Health and Human Services. Additional funding was provided by the Robert Wood Johnson Foundation.
"We know that disparities exist in the health and health care of African Americans and whites," explains Richard Suzman, Ph.D., Associate Director of the NIA for Behavioral and Social Research. "Some researchers focus on doctor-patient interactions as the major factor, while others give more weight to hospital quality. Potential remedies are quite different, depending on which set of factors predominates. This study sheds light on the mechanisms that may be at work in the case of hospital care and heart attacks."
Led by Jonathan Skinner, Ph.D., of Dartmouth Medical School, the research team analyzed the records of nearly all fee-for-service Medicare patients who were treated for AMI at U.S. hospitals between January 1, 1997, and September 30, 2001. More than 1.13 million older adults treated at 4,289 non-Federal hospitals were included in the study.
"Our research is consistent with the view that African Americans tend to go to hospitals where everyone gets lower quality care," Dr. Skinner says. "Targeting quality improvements for all patients at hospitals that disproportionately serve African Americans can improve overall survival, but also deliver an extra dividend by helping to shrink health disparities at the national level."
Skinner and colleagues classified hospitals that treated Medicare beneficiaries with AMI into 10 groups, depending on the extent to which they served African Americans. The 10 hospital groups ranged from those that admitted no African-American AMI patients to those where more than one-third (33.6 percent) of AMI patients were African American.
After adjusting for age, race, sex, and concurrent health problems such as diabetes, the risk-adjusted 90-day mortality after AMI was 20.1 percent in hospitals serving no African Americans and 23.7 percent in hospitals with the greatest share of black AMI patients