title: Care and outcomes of Asian-American acute myocardial infarction patients: findings from the American Heart Association Get With The Guidelines-Coronary Artery Disease program.
abstract: BACKGROUND
  Asian-Americans represent an important United States minority population, yet there are limited data regarding the clinical care and outcomes of Asian-Americans following acute myocardial infarction (AMI). Using data from the American Heart Association Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program, we compared use of and trends in evidence-based care AMI processes and outcome in Asian-American versus white patients.
  
  
  RESULTS
  We analyzed 107,403 AMI patients (4412 Asian-Americans, 4.1%) from 382 United States centers participating in the Get With The Guidelines-Coronary Artery Disease program between 2003 and 2008. Use of 6 AMI performance measures, composite "defect-free" care (proportion receiving all eligible performance measures), door-to-balloon time, and in-hospital mortality were examined. Trends in care over this time period were explored. Compared with whites, Asian-American AMI patients were significantly older, more likely to be covered by Medicaid and recruited in the west region, and had a higher prevalence of diabetes, hypertension, heart failure, and smoking. In-hospital unadjusted mortality was higher among Asian-American patients. Overall, Asian-Americans were comparable with whites regarding the baseline quality of care, except that Asian-Americans were less likely to get smoking cessation counseling (65.6% versus 81.5%). Asian-American AMI patients experienced improvement in the 6 individual measures (P≤0.048), defect-free care (P<0.001), and door-to-balloon time (P<0.001). The improvement rates were similar for both Asian-Americans and whites. Compared with whites, the adjusted in-hospital mortality rate was higher for Asian-Americans (adjusted relative risk: 1.16; 95% confidence interval: 1.00-1.35; P=0.04).
  
  
  CONCLUSIONS
  Evidence-based care for AMI processes improved significantly over the period of 2003 to 2008 for Asian-American and white patients in the Get With The Guidelines-Coronary Artery Disease program. Differences in care between Asian-Americans and whites, when present, were reduced over time.
authors.affiliation: University of Rochester, Rochester, NY 14642, USA. feng_qian@urmc.rochester.edu
authors.forename: Feng
authors.initials: F
authors.lastname: Qian
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Ling
authors.forename: Prakash
authors.initials: P
authors.lastname: Deedwania
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kaltenbach
authors.forename: Warren K
authors.initials: WK
authors.lastname: Laskey
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D001213:Asian; D003695:Delivery of Health Care / Q000639:trends; D055317:Evidence-Based Practice; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D011787:Quality of Health Care / Q000706:statistics & numerical data; D016019:Survival Analysis; D014481:United States; D044465:White People