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Disparities/Minority Health

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Black patients fare worse than white patients after treatment for heart attack or unstable angina

Blacks are 46 percent more likely than whites to suffer from angina (crushing chest pain), have worse quality of life, and experience poor physical function 1 year after being hospitalized for acute coronary syndrome (ACS, unstable angina or heart attack). Black patients with ACS may require closer monitoring to determine if they need additional treatment to improve their health, recommends John A. Spertus, M.D., M.P.H., of Saint Luke's Hospital. Supported by the Agency for Healthcare Research and Quality (HS11282), Dr. Spertus and colleagues compared symptoms, function, and quality of life of 1,159 patients included in a registry of patients with ACS who were treated in 2000 and 2001 at two Kansas City hospitals. Researchers quantified the patients' health status 1 year after ACS treatment using the Seattle Angina Questionnaire (SAQ) and the Short Form-12 Physical Component Score (SF-12 PCS).

Mortality rates were similar among the 196 black and 963 white participants (7.1 vs. 7.0 percent), after adjustment for differences in sociodemographic and clinical characteristics and types of treatment (for example, cardiac catheterization, bypass surgery, and medication). However, 1 year after treatment, more blacks than whites suffered from angina (43.4 vs. 27.1 percent), worse quality of life (SAQ score 70.6 vs. 83.9), and poorer physical function (SF-12 PCS 36.8 vs. 43.2). Adjusting for differences in hospital treatments between black and white patients did not eradicate the racial differences in outcomes in this study. The results suggest that other factors in the care of patients with ACS between hospital discharge and 1 year post-discharge may be responsible for this disparity in outcome, such as differences in outpatient treatment, compliance with antianginal medications, and biologic mechanisms.

See "The influence of race on health status outcomes one year after an acute coronary syndrome," by Dr. Spertus, David Safley, M.D., Mukesh Garg, M.D., and others, in the November 15, 2005, Journal of the American College of Cardiology 46(10), pp. 1838-1844.

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