Abstract
Background: Acute Myocardial Infarction (AMI) care and outcomes disparities have been reported worldwide in women and racial-ethnic minorities. In the U.S., some have attributed disparities in Hispanics and other minorities to lower quality of services at hospitals where they seek care. Current information from hospitals with large Hispanic representation and equitable updated resources is needed. Methods: Retrospective observational study of 839 AMI patients discharged in 2013 from three Southern California Community Hospitals (A, B, C) with tertiary cardiac care level. Non-Hispanic Whites (NHW) and Hispanics (H) were the larger racial-ethnic groups (68.3%). Mortality, 30 day readmissions, medication/performance measures (PRx); Aspirin, Statins/anti-lipids, Beta-blockers, Angiotensin Converting Enzyme Inhibitors and Receptor Blockers for Left Ventricular Systolic dysfunction, <90 minute door-balloon time, and coronary percutaneous interventions and revascularization procedures were compared between Hospitals, NHW and H, and gender using Chi-squared tests (χ 2 ), Odds Ratios (OR) with 95% confidence intervals (CI), and Z tests for proportions -independent groups. Results: No significant differences in hospital, 30 day mortality, or PRx were observed between hospitals, NHW and H. Hospital C had 47.3% Hispanics, Hospitals A+B 14.6% (η 2 =.430, p<0.001). AMI performance measures exceeded 2013 national rates across all facilities. NHW had more private insurance (52.5% vs. 25.4%, OR 3.24, 95% CI 2.19-4.80, p<.001) than Hispanics. Women had similar PRx, mortality, and readmissions, yet less CABG (6.7% vs. 14.1%, OR 0.38, 95% CI 0.21-0.67, p = .001) and Non-STEMI PCI procedures than men (39.1% vs. 51.2%, z = 2.65, p = 0.008) after full data adjustment. Conclusions: Equitable standards of care offset previously reported disparities in AMI management in Hispanics but not in women’s coronary revascularization procedures.
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