Race, Socioeconomic Status Gaps in Revascularization Rates Persist Among Women With ACS

The two-decade study using Women’s Health Initiative data reinforces the need for increased cultural competency among physicians, the presenter says.

Race, Socioeconomic Status Gaps in Revascularization Rates Persist Among Women With ACS

While revascularization rates have broadly increased among postmenopausal women presenting with acute coronary syndromes in the United States, the disparities in care among various racial groups have not narrowed, according to a new study.

It is well known that race and socioeconomic status can and do affect outcomes in cardiovascular disease, but the precise cause of this remains unknown.

“Because different groups have different ways of understanding based on their own experiences, [I think] cultural competency is something that is very important for physicians to understand,” Tarryn Tertulien, BA (Alpert Medical School of Brown University, Providence, RI), who presented the findings today in a poster session at the American Heart Association’s (AHA’s) Quality of Care and Outcomes Research (QCOR) 2019 Scientific Sessions in Arlington, VA, told TCTMD. She also stressed the necessity of physicians to “[be] aware of their own implicit biases when they see patients coming in with certain symptoms.”

In 2002, the American College of Cardiology and the AHA released an update to the standard treatment guidelines of patients with unstable angina and NSTEMI. Given that guidelines usually take a few years to be embedded into general practice, Tertulien and colleagues looked at revascularization rates of more than 20,000 postmenopausal women—including 17,509 who were white, 2,181 who were black, and 572 who were Hispanic—from the Women’s Health Initiative from before and after 2005.

Overall revascularization rates increased for the study population between 1993 and 2018. However, black and Hispanic women were generally less likely to be revascularized for ACS or coronary heart disease compared with white women before and after 2005.

Revascularization Rates by Race, Versus White

 

Pre-2005

Post-2005

 

HR

95% CI

HR

95% CI

Black

 

 

 

 

    ACS or CHD

0.50

0.45-0.57

0.50

0.43-0.58

    STEMI

0.85

0.59-1.24

0.61

0.38-0.98

    NSTEMI

1.08

0.76-1.56

0.73

0.54-1.01

Hispanic

 

 

 

 

    ACS or CHD

0.77

0.63-0.94

0.93

0.74-1.16

    STEMI

1.82

0.93-3.55

0.92

0.47-1.81

    NSTEMI

2.36

1.40-3.97

1.10

0.69-1.74

Abbreviation: CHD, coronary heart disease.

Interestingly, there were no differences found in revascularization rates for women defined as having low versus high socioeconomic status throughout the study period, although women at low socioeconomic status tended to be revascularized less often than their high socioeconomic status counterparts after 2005.

Revascularization Rates, Low Versus High Socioeconomic Status

 

Pre-2005

Post-2005

 

HR

95% CI

HR

95% CI

ACS or CHD

1.02

0.85-1.09

0.91

0.83-1.01

STEMI

0.93

0.76-1.13

1.02

0.77-1.34

NSTEMI

0.83

0.66-1.02

0.92

0.73-1.15


The gaps in revascularization rates persisted after accounting for education, income, insurance status, and other complications, including diabetes and hypertension, Tertulien said. These data do not give any indication as to why this might be happening, she added, but “there's definitely a need to better understand the disparities that are out there in terms of cardiovascular risk factors so that clinicians and public health professionals can have greater cultural sensitivity in terms of knowing how to address this, in terms of increasing patient education about symptoms when they do experience them, [and] the kind of services that can be targeted at certain minority groups and communities.”

Sources
  • Tertulien T. Secular trends in racial and socioeconomic status disparities in the rate of coronary revascularization among post-menopausal women before and after 2005 for acute coronary syndrome: the Women Health Initiative. Presented at: QCOR 2019. April 5, 2019. Arlington, VA.

Disclosures
  • Tertulien reports no relevant conflicts of interest.

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