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Heart Attack Guidelines Close Racial Gaps in Hospital Care
Date:5/17/2010

But they're not enough to guarantee complete parity in treatment, expert says

MONDAY, May 17 (HealthDay News) -- Hospitals using guidelines from the American Heart Association have been able to eliminate racial and ethnic disparities when caring for heart attack patients, a new study finds.

Called Get With The Guidelines, the program shows that disparities in care can be eliminated while at the same time improving overall care, the researchers say.

"Using a system that provides feedback about the use of performance measures decreases racial disparities over time," said lead researcher Dr. Mauricio G. Cohen, an associate professor of medicine in the cardiovascular division of the University of Miami Miller School of Medicine.

"While overall care improved over time, the difference in care of minority patients started to decrease over time and by the end of the study these difference were eliminated," he added.

The report is published in the May 17 online edition of Circulation.

For the study, Cohen's group looked at the medical records of 142,593, white, black and Hispanic patients being treated for heart attack in 443 hospitals that use the guidelines. Currently, almost 1,500 of the over 7,000 U.S. hospitals use the Get With The Guidelines program, according to the American Heart Association.

The guidelines for treating heart attack include therapies such as giving medications like aspirin and blood pressure drugs, and starting patients on statins to lower cholesterol. The guidelines also call for helping people change their lifestyles, for example, by stopping smoking.

The researchers looked at the overall rate of patients getting a combination of the treatments for which they were eligible, known as "defect-free care." At the start of the study in 2002, Cohen's team saw a gap in defect-free care for blacks, but by 2007 it was gone.

Specifically:

  • In 2002, 68 percent of white patients received defect-free care, compared with 93 percent in 2007.
  • In 2002, 58 percent of black patients received defect-free care, compared with 93 percent in 2007.
  • In 2002, 65 percent of Hispanic patients received defect-free care, compared with 95 percent by 2007.

Over the five years of the study, defect-free care overall was 81 percent for whites, 79.5 percent for Hispanics and 77.7 percent for blacks. These differences resulted from the unequal care given during the early years of the study, Cohen said.

"These findings are reassuring," Cohen said. "We need to engage hospitals in quality monitoring and improvement programs," he added.

Dr. Nakela L. Cook, from the U.S. National Heart, Lung, and Blood Institute and author of an accompanying journal editorial, said that eliminating 100 percent of disparities in care is a worthy goal, however, other factors in addition to quality assurance programs also play a role.

"This study does not take into account the many factors that we use to estimate quality of care," she said. "Such factors may include health literacy, economic status, and social support. Addressing these factors may be crucial to eliminating disparities."

In addition, there may be a misperception that disparities are disappearing, she said. "The authors did see that disparities in these measures disappear over the time. However, these measures evaluate short-term aspects of care, and while important in their own right, they are limited in their ability to predict long-term outcomes in disparities," Cook said.

Cook added that it is not clear that this quality improvement program alone eliminated disparities. "It is possible that increased attention to disparities in these hospitals may have resulted in other programs that are not assessed in this study," she said.

Disparities in care are a significant problem, Cook noted.

"We need to shift our focus from identifying disparities to finding solutions to eliminate disparities," she explained. "Quality improvement programs may be one way in which we can do this, but the field and patients will benefit from ongoing research to find the most successful approaches to do this."

More information

For more information on Get With The Guidelines, visit the American Heart Association.



SOURCES: Mauricio G. Cohen, M.D., associate professor, medicine, cardiovascular division, University of Miami Miller School of Medicine; Nakela L. Cook, M.D., M.P.H., U.S. National Heart, Lung, and Blood Institute, Bethesda, Md.; May 17, 2010, Circulation, online


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