Treatment and Medication

Overall, black patients have been found to experience longer delays in receiving drug or surgical treatments compared to white patients. Black patients in the Think Symptoms study had significantly longer prehospital delays than whites.6 In a large cohort of patients from the National Registry of Myocardial Infarction, door‐to‐drug times were longest for black patients and door‐to‐balloon times were significantly longer for blacks than for whites.12 In a study of patients undergoing primary percutaneous coronary intervention (PCI) as part of the American Heart Association Get With The Guidelines (GWTG) study, insignificant differences were found in door‐to‐balloon times between white and black patients, with similar in‐hospital mortality rates between groups.13 However, after adjusting for confounding factors, being black was associated with a lower likelihood of door‐to‐balloon times of <90 minutes (a quality‐of‐care indicator for treatment of ST‐segment elevation myocardial infarction [STEMI]) relative to being white.13

In a study of Medicare beneficiaries with AMI who were admitted to hospitals without revascularization facilities, it was found that it took a median of 2 days to transfer black patients to a revascularization hospital, but a median of 1 day for whites (risk‐standardized mortality rate in the revascularization hospitals did not differ between black and white patients).14 In a cohort of 1 215 924 black and white Medicare beneficiaries (≥68 years) admitted with AMI between 2000 and 2005, black patients admitted to nonrevascularization hospitals were significantly less likely to be transferred to a hospital with revascularization facilities, and significantly less likely to receive revascularization than white patients. After adjustment for sociodemographics, comorbidity, and severity of disease, the disparities between transfer and revascularization rates remained significant.15

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County‐level hospital capacity, measured as the number of cardiac revascularization hospitals per capita, may explain some of the observed racial disparity in treatment of PCI and coronary artery bypass graft (CABG). To gauge the impact of this factor, 1 study assessed data from 207 570 Medicare patients admitted for AMI in Pennsylvania (between 1995 and 2006).16, 17 Blacks were significantly less likely than whites to be treated with either CABG or PCI within 3 months of AMI. Furthermore, this racial disparity in CABG treatment remained similar in counties with differing AMI hospital capacity, whereas the PCI rate disparity was larger in counties with the lowest AMI hospital capacity.17

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