June 22, 2000
Posted on June 22, 2000 at 10:27 a.m. BIRMINGHAM, AL — UAB (University of Alabama at Birmingham) cardiologist and director of UAB's Chest Pain Center John Canto, M.D., and colleagues have recently received national attention for their landmark studies characterizing heart attack patients. In the last six months, UAB cardiologists have published four separate studies in three separate leading medical journals, including New England Journal of Medicine, Journal of the American Medical Association and Archives of Internal Medicine. All four studies examine huge numbers of collected medical records of patients who have suffered heart attacks. The medical records come from two separate national databases, the national Medicare database and the National Myocardial Infarction Registry 2, both of which are collected from hospitals across the country. |
In a study looking at 234,769 Medicare patients with heart attacks:
- Blacks are less likely to receive potential life-saving therapy after the onset of chest pain.
- White men received either drug therapy or coronary angioplasty with the highest frequency, followed by white women, black men and black women. After adjustments were made for clinical differences such as age, prevalence of other diseases and smoking habits, gender differences became minimal but the racial differences remained the same.
- The racial disparities have many possible explanations, including possible differences in clinical characteristics such as diagnostic testing and symptoms that make diagnosis and the decision to treat with drug therapy more difficult for doctors.
In a study looking at 332,221 patients with heart attacks:
- Significant variation of types of treatment exists depending on whether a heart attack patient has commercial insurance, a health maintenance organization insurance, no insurance, Medicare or Medicaid.
- The type of payment method has no effect on the death rate of heart attack patients.
- Of the 332,221 patients, 56 percent had Medicare, 25 percent had commercial insurance, 10 percent were covered by an HMO, 6 percent were uninsured and 3 percent used Medicaid.
- Compared with commercially insured patients, Medicare and Medicaid patients received fewer reperfusion therapies, underwent fewer invasive cardiac procedures and had longer hospitalizations.
In a study looking at 534,763 patients with heart attacks:
- Heart attack patients undergoing immediate coronary angioplasty are 28 percent less likely to die at hospitals that routinely perform more of the procedures. The percentage is equivalent to two fewer deaths per 100 patients treated.
- There is no difference in survival rates among patients who received thrombolytic therapy, or drug therapy widely used to improve blood flow to the heart after a heart attack.
- High-volume centers tended to administer life-saving reperfusion therapies faster than low-volume centers and the difference of time was greater for patients who underwent angioplasty than those who received drug therapy.
- The study supports the American College of Cardiology-American Heart Association recommendation that angioplasty should be used as an alternative to drug therapy only if performed in a timely fashion by individuals skilled in the procedure and supported by experienced personnel in a high-volume center.