Women, Minorities Less Likely to Get Best Heart Attack Care

White male patients are most often transferred to high-quality medical centers, study finds

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By Janice Billingsley
HealthDay Reporter

MONDAY, March 13, 2006 (HealthDay News) -- When it comes to receiving the best care after heart attack, the deck is stacked against women, minority populations and older people, new research suggests.

Thirty-five percent of patients over age 64 who are rushed to local community hospitals with acute heart attacks are then transferred to larger hospitals for more aggressive interventions -- procedures known to improve survival rates, the researchers said.

But the study found that, in many cases, a person's medical condition has little to do with the decision of who gets to go to the larger hospitals.

Besides health concerns, "age, gender and race are predictive of whether or not patients are transferred after a heart attack from a community hospital to a larger hospital," said lead researcher Dr. Jeffrey Berger, a cardiology fellow at Duke University Medical Center.

His team found that younger, white males were significantly more likely to be sent to high-quality care at larger centers, compared to women or minority patients.

Treatment at larger centers, which have the technology and staff to perform angioplasty and bypass surgery, does make a difference in terms of patient outcomes, Berger said. In their analysis of nearly 400,000 cases involving patients over the age of 64, the researchers found post-heart attack mortality rates of 8.7 percent for patients transferred to larger centers vs. 18.5 percent for those treated at smaller community centers.

Heart attack treatment at community hospitals includes giving the patient powerful clot-busting drugs, Berger said. But he noted that research has shown that, even with the added transfer time to another hospital, surgical interventions tend to have a better outcome than using drugs when it comes to treating a heart attack.

Berger presented the findings Sunday during the annual scientific sessions of the American College of Cardiology, in Atlanta.

In the study, the Duke team looked at 2001-2003 data from the U.S. Centers for Medicare and Medicaid Services. During that time period, a total of 399,775 patients over 64 were admitted to hospitals without the resources to perform angioplasty or bypass surgery. Just over one-third of these patients were subsequently transferred to a larger facility where these procedures were performed.

According to the data, younger, white men with less serious heart attacks were more likely to be transferred to the larger hospitals, Berger said.

Women were 16 percent less likely to be transferred compared to men, the study found. Compared to white patients, African-Americans were 31 percent less likely to be transferred, and Hispanics, 47 percent less likely to be transferred. Age was another deciding factor. As age increased, so too did the likelihood that patients would be kept at a community hospital.

"Our findings underline ongoing concerns about disparity in health care in certain subgroups," Berger said. Teasing out the reasons for these inequities is difficult -- "they could be societal, patient or health care-based," he said.

Societal reasons could include the fact that people from poorer socioeconomic backgrounds have fewer options for transfers, Berger said. Some patients might also refuse to be transferred because they feel more comfortable closer to home, he said. Health-care factors, such as the assumption that older patients are less likely to benefit from more aggressive interventions, might also play a role.

"Further research is required to translate these findings into an improvement of health-care quality," Berger said.

The Duke study is just one of many papers on gender and racial disparities in health care being presented at the Atlanta meeting. According to Dr. Nieca Goldberg, the chief of women's cardiac care at New York City's Lenox Hill Hospital, "some of the sickest patients don't have access to really important care, and we need to evaluate the potential reasons and find the ways to improve care."

More information

For more on spotting and treating a heart attack, head to the National Heart, Lung, and Blood Institute.

SOURCES: Jeffrey Berger, M.D., M.S., cardiology fellow, Duke University Medical Center, Durham, N.C.; Nieca Goldberg, M.D., chief, women's cardiac care, Lenox Hill Hospital, New York City; March 12, 2006, presentation, 55th annual scientific sessions, American College of Cardiology, Atlanta

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