Does a Patient’s Neighborhood Affect MI Care?
Patients from disadvantaged neighborhoods may receive similar care for myocardial infarction (MI) as those from higher-income neighborhoods, but may be at higher risk of adverse in-hospital outcomes, according to a study published May 30 in Circulation: Cardiovascular Quality and Outcomes.
Jacob A. Udell, MD, MPH, et al., used data from ACC's Chest Pain – MI Registry, formerly the ACTION Registry, and the U.S. Census Bureau to look at 390,692 MI patients who received treatment at 586 hospitals between 2008 and 2013.
Results showed that neighborhood socioeconomic status, insurance status and hospital characteristics were not associated with lower rates of guideline-recommended care. However, patients from disadvantaged neighborhoods waited longer for angiography after arriving at the hospital (8 hours for the lowest quintile vs. 3.4 hours for the highest quintile) and were less likely to receive referrals for cardiac rehabilitation at discharge (72.1 percent for the lowest quintile vs. 78.2 percent for the highest quintile). In addition, patients from lower-income neighborhoods were at a higher risk of adverse in-hospital outcomes, including mortality and major bleeding, regardless of clinical risk factors, insurance status and hospital characteristics.
Although patients living in the most disadvantaged neighborhoods “receive equitable in-hospital care” for MI as those living in higher-income neighborhoods, the researchers note that their study’s findings “suggest there are further opportunities for improvement” in reducing time to angiography and increasing cardiac rehab referrals. They conclude that further research should examine reasons for the disparities.
Keywords: Cardiac Rehabilitation, Risk Factors, Vulnerable Populations, Social Class, Income, Myocardial Infarction, Residence Characteristics, Chest Pain, Insurance Coverage, Registries, Angiography, National Cardiovascular Data Registries, Chest Pain MI Registry
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