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Study shows racial disparity in treatment for patients recovering from heart attacks

Contributed by UNC School of Medicine.

A study by the UNC School of Medicine found racial disparities in the treatment of NSTEMI — a type of heart attack caused by a partial blockage of the artery — are still present. 

Published in the Journal of the American Heart Association, cardiology fellow Sameer Arora and his team found that from 2000 to 2014, there were differences in how white and black patients have been treated for this heart issue.

Arora said increasingly standardized processes for diagnosis and treatment of most heart attacks were expected to narrow these differences, but this is not the case for NSTEMI.

“We concluded that despite standardizations of care, we still found that these differences have persisted between white and black patients,” he said. “We talked about how other measures are required to narrow down these disparities and differences.”

Arora said differences exist in how white and black patients are treated for this type of heart attack because doctors have more discretion in diagnosing NSTEMI than they do in STEMI, which is a heart attack caused by a completely blocked artery. 

“There has to be an elevation of the cardiac biomarkers. There has to be some EKG changes, but not all the patients who have NSTEMI need to have EKG changes,” he said. “The diagnosis is more reliant on physicians, so a physician might call it an NSTEMI whereas another physician might not call it an NSTEMI.”

According to the study, Black patients were less likely to receive aggressive treatments: 29 percent less for angiography and 45 percent less for revascularization. 

They were also 6 percent less likely to be given aspirin for their pain.

This disparity, Arora said, could be due to health differences in African-American patients and white patients that might make some doctors not want to give a patient a treatment their body cannot handle, Arora said.

“Black communities and black patients belong, usually, to a sicker cohort,” he said. “They have a higher prevalence of high blood pressure, diabetes — a lot of that is genetic, some of that is related to their communities so a lot of different factors go in there.”

Rick Stouffer, chief of cardiology at the School of Medicine and co-author of the study, said the study discovered differences in how black and white patients are treated for NSTEMI but exact reasons are still unknown.

“It may be equally as likely that there’s something different in the Black population about why they’re having heart attacks at a younger age, why women are more likely to have heart attacks," Stouffer said. "Those questions all need to be sorted out in future research."

Stouffer said this study is just the first step in discovering why these differences exist and the end goal is improving the care these patients receive.

“Now that we’ve shown differences between the races, let’s figure out why,” he said. “If there’s some way that we can use this data to improve the care of patients with heart attacks, it’s by understanding the process better."


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