Recent and temporal trends (1975 to 1999) in the treatment, hospital, and long-term outcomes of Hispanic and non-Hispanic white patients hospitalized with acute myocardial infarction: a population-based perspective.
BACKGROUND
Extremely limited population-based data are available describing recent and temporal trends in the characteristics, treatment, and outcomes of Hispanic and non-Hispanic white patients hospitalized with acute myocardial infarction (AMI).


METHODS
This was a community-based, observational study of 9649 greater Worcester residents hospitalized in all hospitals serving the Worcester, Massachusetts, metropolitan area in 12 one-year periods between 1975 and 1999. In the total study sample, 171 (2%) patients were Hispanic. Hispanic patients were matched with 395 non-Hispanic white patients on the basis of age, sex, and year of hospitalization.


RESULTS
Hispanics were more likely to present to greater Worcester hospitals with a history of diabetes as compared with non-Hispanic whites. Hispanics were less likely to have an initial, Q-wave AMI during the index hospitalization. After controlling for a limited number of known potentially confounding factors, Hispanics were at lower risk for development of heart failure (OR, 0.63; 95% CI, 0.41, 0.96). Both Hispanics (13% vs 11%) and non-Hispanic whites (28% vs 9%), however, had declines in hospital case-fatality rates between 1975 and 1999. An overall similar treatment pattern and increasing trends in the use of effective cardiac medications over time were observed in both patient groups. However, Hispanics were significantly less likely to be treated with coronary angioplasty during the acute hospitalization. Trends of a worse long-term survival for discharged Hispanic patients were observed over a 10-year follow-up period.


CONCLUSIONS
The results of this community-wide study suggest encouraging hospital outcomes in Hispanic and non-Hispanic white patients hospitalized with AMI. Enhanced secondary prevention efforts remain needed to improve the hospital and long-term outcomes of patients with AMI, irrespective of race or ethnicity.
Yarzebski
Jorge
J
Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester 01655, USA. jorge.yarzebski@umassmed.edu
Bujor
Carmen F
CF
Lessard
Darleen
D
Gore
Joel M
JM
Goldberg
Robert J
RJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000639:trends; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000639:trends; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000208:ethnology* / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents