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Racial variations in treatment and outcomes of black and white patients with high-risk non-ST-elevation acute coronary syndromes: insights from CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines?).

Publication ,  Journal Article
Sonel, AF; Good, CB; Mulgund, J; Roe, MT; Gibler, WB; Smith, SC; Cohen, MG; Pollack, CV; Ohman, EM; Peterson, ED; CRUSADE Investigators,
Published in: Circulation
March 15, 2005

BACKGROUND: Black patients with acute myocardial infarction are less likely than whites to receive coronary interventions. It is unknown whether racial disparities exist for other treatments for non-ST-segment elevation acute coronary syndromes (NSTE ACS) and how different treatments affect outcomes. METHODS AND RESULTS: Using data from 400 US hospitals participating in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines?) National Quality Improvement Initiative, we identified black and white patients with high-risk NSTE ACS (positive cardiac markers and/or ischemic ST-segment changes). After adjustment for demographics and medical comorbidity, we compared the use of therapies recommended by the American College of Cardiology/American Heart Association guidelines for NSTE ACS and outcomes by race. Our study included 37,813 (87.3%) white and 5504 (12.7%) black patients. Black patients were younger; were more likely to have hypertension, diabetes, heart failure, and renal insufficiency; and were less likely to have insurance coverage or primary cardiology care. Black patients had a similar or higher likelihood than whites of receiving older ACS treatments such as aspirin, beta-blockers, or ACE inhibitors but were significantly less likely to receive newer ACS therapies, including acute glycoprotein IIb/IIIa inhibitors, acute and discharge clopidogrel, and statin therapy at discharge. Blacks were also less likely to receive cardiac catheterization, revascularization procedures, or smoking cessation counseling. Acute risk-adjusted outcomes were similar between black and white patients. CONCLUSIONS: Black patients with NSTE ACS were less likely than whites to receive many evidence-based treatments, particularly those that are costly or newer. Longitudinal studies are needed to assess the long-term impact of these treatment disparities on clinical outcomes.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

March 15, 2005

Volume

111

Issue

10

Start / End Page

1225 / 1232

Location

United States

Related Subject Headings

  • White People
  • United States
  • Treatment Outcome
  • Smoking Cessation
  • Risk Assessment
  • Risk
  • Practice Guidelines as Topic
  • Myocardial Revascularization
  • Myocardial Infarction
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
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Sonel, A. F., Good, C. B., Mulgund, J., Roe, M. T., Gibler, W. B., Smith, S. C., … CRUSADE Investigators, . (2005). Racial variations in treatment and outcomes of black and white patients with high-risk non-ST-elevation acute coronary syndromes: insights from CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines?). Circulation, 111(10), 1225–1232. https://doi.org/10.1161/01.CIR.0000157732.03358.64
Sonel, Ali F., Chester B. Good, Jyotsna Mulgund, Matthew T. Roe, W Brian Gibler, Sidney C. Smith, Mauricio G. Cohen, et al. “Racial variations in treatment and outcomes of black and white patients with high-risk non-ST-elevation acute coronary syndromes: insights from CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines?).Circulation 111, no. 10 (March 15, 2005): 1225–32. https://doi.org/10.1161/01.CIR.0000157732.03358.64.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

March 15, 2005

Volume

111

Issue

10

Start / End Page

1225 / 1232

Location

United States

Related Subject Headings

  • White People
  • United States
  • Treatment Outcome
  • Smoking Cessation
  • Risk Assessment
  • Risk
  • Practice Guidelines as Topic
  • Myocardial Revascularization
  • Myocardial Infarction
  • Middle Aged