Black heart patients less often go to top hospitals

NEW YORK (Reuters Health) - When older African Americans suffer a heart attack, they are less likely than their white counterparts to go to a hospital that performs potentially life-saving heart procedures, a new study suggests.

Researchers say the findings point to one potential reason why African Americans are less likely than whites to receive guideline-recommended treatments for heart attacks.

The study, which looked at Medicare records for more than 65,000 heart attack patients, found that black patients were 12 percent less likely than whites to go to a "high-quality" hospital and 17 percent more likely to arrive at a "low-quality" hospital.

What's more, blacks were less likely than white patients to go to a hospital that performed angioplasty and bypass surgery -- two procedures commonly used to clear the artery blockages causing the heart attack.

The reasons for the findings, reported in the journal Circulation, are not clear.

But the specific neighborhoods in which people live may be key, according to lead researcher Dr. Ioana Popescu of the University of California, Los Angeles.

That's because when she and her colleagues compared only patients living within the same zip code, the racial discrepancy disappeared.

In raw numbers, in fact, a slightly higher percentage of black patients were seen at the hospitals offering the best heart attack treatments: 61 percent, versus 59 percent of white patients.

But when the researchers adjusted their statistical analysis to account for the fact that African Americans, on average, lived closer to the best hospitals, it turned out that black patients were 13 percent less likely than whites to be admitted to those hospitals.

The issue may not be race, per se, Popescu told Reuters Health, but the "context" of the neighborhood in which people live -- like income and education levels, and people's general access to more-routine healthcare.

"I think this really points to the importance of location, and what kinds of choices people have in their local healthcare market," Popescu said.

"As far as research," she added, "we really have to look at the relationship between where people live and what kind of care they get."

A limitation of this study, Popescu said, is that it had no information on how patients got to the hospital -- on their own, or by ambulance. So it's not clear whether, for example, black patients were less likely to call an ambulance.

Nor is it clear, the authors note, whether among heart attack sufferers who choose which hospital to go to, preferences for specific doctors or institutions are among the sociological factors that influence those choices.

But if you are suffering potential heart attack symptoms, Popescu said, it's always wise to call 911 -- in part, because paramedics should know whether a particular nearby hospital is best equipped to handle heart attacks.

"But that means that people also need to be educated about the signs of a heart attack," Popescu said.

Potential signs of a heart attack include feelings of pain, pressure or squeezing in the chest, shortness of breath, light-headedness, nausea, or pain in the arms, back, neck or jaw.

The current findings are based on 65,633 Medicare patients who were treated for heart attacks in 2005, in any of 63 hospital referral regions across the country.

Popescu's team gave each hospital a quality score, based on the center's 30-day death rate and whether it met certain standards for treating heart attacks -- like getting patients started on aspirin and heart drugs called beta-blockers within 24 hours.

Overall, 25 percent of white patients were admitted to a hospital that scored in the top 20 percent for quality. That compared with 21 percent of black patients.

On the other hand, 11 percent of black patients and 9 percent of whites were taken to a hospital in the bottom 20 percent.

The findings, according to Popescu, offer one possible reason for the race gap in heart attack treatment.

Past studies have found that African Americans are less likely than whites to receive generally recommended heart attack therapies -- particularly ones that are newer or expensive. Those include prescriptions for cholesterol-lowering statin drugs, as well as invasive procedures like angioplasty.

In one study of U.S. hospitals, black patients were about 30 percent less likely than whites to receive angioplasty within 48 hours. That was with age, overall health and insurance coverage taken into account.

SOURCE: bit.ly/jf8Oo4 Circulation, online May 31, 2011.