Hospital, not race, a factor in heart attack care

Much of the racial and ethnic differences in the care given to patients hospitalized with a heart attack can be explained by the quality of the hospital to which patients are admitted, rather than racial bias, a new study indicates.

The differences in treatment were "related to hospital quality to a large extent," senior investigator Dr. Harlan M. Krumholz told Reuters Health. "Eliminating disparities in this country is going to be accomplished at least in part by raising the level of care at hospitals throughout the country, particularly those that care for minority populations."

Krumholz, at Yale University School of Medicine in New Haven, Connecticut, and colleagues examined the lag between a heart attack patient being admitted to a hospital and the start of actual treatment.

The data, obtained from a national registry, included approximately 100,000 patients treated at almost 1500 hospitals.

When grouped by race/ethnicity, time to treatment with clot-busting drugs was longest for African Americans - 41 minutes - versus 36 minutes for Hispanics, and 34 minutes for whites, the researchers report in this week's Journal of the American Medical Association.

Treatment times for those undergoing angioplasty were 122 minutes, 115 minutes, and 103 minutes for the three groups, respectively.

However, differences among the groups were significantly reduced after accounting for the hospitals in which patients were treated, as well as their age, gender, and insurance status.

After full adjustment for patient- and hospital-related factors, the difference between blacks and whites in time to getting clot-busters was 5 minutes, and the difference between Hispanics and whites was on average 1 minute. The corresponding differences in angioplasty treatment time came down to 8 minutes and 4 minutes.

"It seems there are some fundamental things that the very best hospitals are doing, that we believe aren't really present at the other hospitals," Krumholz said.

"The big difference is whether the hospital has taken the effort to really understand the steps required to deliver this kind of treatment quickly," he continued, and whether they are working "to ensure that every patient gets it as quickly as possible."

SOURCE: Journal of the American Medical Association, October 6, 2004.