Heart attack outcomes worse among blacks

African American patients fare worse following a heart attack than do Caucasian patients, and it's not for any genetic reason or because of any great differences in treatment, new research indicates.

Individual characteristics - including the presence of other illnesses and socioeconomic factors - are the underlying cause of the difference in outcomes.

Those findings come from Dr. John A. Spertus, at the Mid America Heart Institute in Kansas City, Missouri, and co-investigators. They analyzed data from a registry of 1849 patients who survived a heart attack; 28 percent were African American.

According to the team's report in the Annals of Internal Medicine, significantly more black patients than white patients died within two years - 19.9 percent vs 9.3 percent.

Also, rates of sever chest pain were higher among blacks than whites (28.0 percent vs 17.8 percent), and their quality of life scores were worse.

In general, the investigators report, most of the differences in outcome between black and white patients were explained by "patient characteristics present before admission."

For example, black patients had significantly higher rates of diabetes, chronic heart failure and kidney failure, and high blood pressure. Indicators of socioeconomic status, such as health insurance coverage and income, were lower, and they were also less likely to be married.

There was some indication that the greater mortality among black patients was related to hospital quality. Furthermore, white patients were more likely to undergo a procedure to unblock clogged coronary arteries.

Still, "no single omission in the care offered black patients would, if overcome, eradicate the crude differences in observed outcomes," the researchers conclude.

SOURCE: Annals of Internal Medicine, March 3, 2009.