Racial and Ethnic Differences in the Treatment of Acute Myocardial Infarction Findings From the Get With The Guidelines-Coronary Artery Disease Program

Article

关键词: ASSOCIATION TASK-FORCE;    DEVELOP PERFORMANCE-MEASURES;    MEASURES WRITING COMMITTEE;    RAPID RISK STRATIFICATION;    SUPPRESS ADVERSE OUTCOMES;    UNSTABLE ANGINA;    AMERICAN-COLLEGE;    ST-ELEVATION;    CARDIOVASCULAR-DISEASE;    EARLY IMPLEMENTATION;   

DOI  :  10.1161/CIRCULATIONAHA.109.922286

来源: SCIE

【 摘 要 】

Background-Racial/ethnic differences in cardiovascular care have been well documented. We sought to determine whether racial/ethnic differences in evidence-based acute myocardial infarction care persist among hospitals participating in a national quality improvement program. Methods and Results-We analyzed 142 593 acute myocardial infarction patients (121 528 whites, 10 882 blacks, and 10 183 Hispanics) at 443 hospitals participating in the Get With the Guidelines-Coronary Artery Disease (GWTG-CAD) program between January 2002 and June 2007. We examined individual and overall composite rates of defect-free care, defined as the proportion of patients receiving all eligible performance measures. In addition, we examined temporal trends in use of performance measures according to race/ethnicity by calendar quarter. Overall, individual performance measure use was high, ranging from 78% for use of angiotensin-converting enzyme inhibitors to 96% for use of aspirin at discharge. Use of each of these improved significantly over the 5 years of study. Overall, defect-free care was 80.9% for whites, 79.5% for Hispanics (adjusted odds ratio versus whites 1.00, 95% confidence interval 0.94 to 1.06, P = 0.94), and 77.7% for blacks (adjusted odds ratio versus whites 0.93, 95% confidence interval 0.87 to 0.98, P = 0.01). A significant gap in defect-free care was observed for blacks mostly during the first half of the study, which was no longer present during the remainder of the study. Overall, progressive improvements in defect-free care were observed regardless of race/ethnic groups. Conclusions-Among hospitals engaged in a national quality monitoring and improvement program, evidence-based care for acute myocardial infarction appeared to improve over time for patients irrespective of race/ethnicity, and differences in care by race/ethnicity care were reduced or eliminated. (Circulation. 2010; 121: 2294-2301.)

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