Blacks and women experience significantly higher rates of post–myocardial infarction (MI) angina and 1-year unplanned rehospitalization rates than whites or men, according to an analysis involving more than 11,590 patients published in the American Heart Association’s journal Circulation.
The presence of angina at 6 weeks following discharge was the factor most strongly associated with rehospitalization, says Tracy Y. Wang, MD, MSc, a Duke cardiologist and lead author.
“From a clinician’s standpoint, these data tell us to focus on the patient in front of us,” Wang says. “Ask about angina, treat it properly, and reduce the possibility of rehospitalization.”
Cardiologists must put greater emphasis on cardiac rehabilitation programs to improve outcomes and quality of life, Wang says. Antianginal medications are underprescribed, and revascularization should be recommended more often.
“We’re seeing persistent gaps in how these therapies are being used,” Wang says. “Many studies have shown that women and blacks face gaps in care. We are trying to get the ‘why’ to focus on angina treatment after percutaneous coronary intervention to reduce hospitalization.”
Using data from the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) study, researchers followed patients for up to 15 months post-MI to ask questions about angina and quality of life. The patients were enrolled from 233 US-based hospitals.
Although the incidence of hospitalization for MI has decreased in the last 20 years, the authors noted that rates of decline have been lower for blacks compared with whites. In addition, the study reported racial and sex disparities in MI treatment and in clinical outcomes post-MI. Significant differences in 30-day readmission rates post-MI were reported.
Among the 11,595 patients who survived to 1 year after discharge, 66.6% were white men, 24.3% white women, 5.3% were black men, and 3.8% were black women. Overall, 29.7% experienced angina at 6 weeks and 20.6% had angina at 1 year following discharge.
Relative to white patients, blacks were more likely to have angina at 6 weeks (women: 44.2% vs 31.8%; men: 33.5% vs 27.1%) and 1 year (women: 49.4% vs 38.9%; men: 46.3% vs 31.1%). Rates of 1-year rehospitalization were highest among black women (44.1%), followed by white women (38.4%), black men (36.4%), and white men (30.2%).
“My ultimate goal is to move the dialogue away from racial and sex disparities in treatment,” Wang says. “No one wants to be in the business of treating certain patients with angina differently.”
A practicing cardiologist and faculty member of the Duke Clinical Research Institute, Wang has published extensively on care quality assessment, health disparities, and comparative effectiveness and safety.