Acute coronary syndromes in black Americans: is treatment different? Should it be?
Black Americans with acute coronary syndromes (ACS) are at greater risk and have poorer outcomes than white Americans. The reasons for this appears, at least in part, to be due to a greater burden of baseline risk factors, longer delays prior to seeking medical care, and underutilization of aggressive treatment strategies in high-risk individuals. A guiding principle of treatment of ACS is that patients at highest risk should receive the most immediate and aggressive therapy. However, compared with whites, blacks with ACS paradoxically receive less aggressive medical therapy, and are less often referred for cardiac catheterization, percutaneous coronary interventions, and bypass surgery. Treatment is--but should not be--different in black Americans. Changing this and improving care for ACS in blacks requires better strategies for decreasing patient delays, earlier recognition and diagnosis of ACS, and more effective implementation of evidence-based treatment guidelines.
Clark
Luther T
LT
Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA. ltclark@downstate.edu
Lingegowda
Umesh
U
D001741:Black or African American; D000789:Angina, Unstable / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D006301:Health Services Needs and Demand; D006801:Humans; D009203:Myocardial Infarction / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors