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(Circulation. 2000;102:943.)
© 2000 American Heart Association, Inc.

Editorials

Gaps In Quality of Cardiovascular Care Transcend Social Bias

Thomas H. Lee, MD

From Partners Community HealthCare, Inc, and the Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass.

Correspondence and reprint requests to Thomas H. Lee, MD, MSc, Partners Community HealthCare, Inc, Prudential Tower Suite 1150, 800 Boylston St, Boston, MA 02199. E-mail thlee@partners.org

Key Words: Editorials • myocardial infarction • race • gender • poverty

At first glance, the article by Rathore et al,¹ which appeared in a recent issue of the journal and is on demographic and socioeconomic differences in the treatment of acute myocardial infarction,¹ seems to be one more study showing that being a middle-to-upper class white male has its advantages in this world—even during an acute myocardial infarction. Other investigations have shown that such patients are more likely to receive invasive procedures during the treatment of acute myocardial infarction. The new contribution shows that women, blacks, and the poor are less likely to receive medical therapies known to improve outcomes, including reperfusion, aspirin, and ß-blockers.

Before filing this article under the category of "Health Policy," readers should look carefully at Table 3. This table shows the actual rates for the utilization of various interventions among "ideal patients." The remarkable database used in this study was collected from detailed chart reviews for 169 079 Medicare patients who had confirmed acute myocardial infarctions from January 1994 to February 1996. These clinical data were used to exclude patients with relative contraindications to reperfusion, aspirin, or ß-blocker therapy. The investigators were able to adjust for issues such as severity of illness, physician specialty, and hospital and geographic characteristics.

As shown in that table, a 5% difference exists in the rates of use of ß-blockers at discharge between white and black patients who are ideal for this therapy. Multivariate analysis confirms that this difference is statistically significant. However, note the rates of use of ß-blockers in . . . [Full Text of this Article]

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