title: Differences in short-term versus long-term outcomes of older black versus white patients with myocardial infarction: findings from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of American College of Cardiology/American Heart Association Guidelines (CRUSADE).
abstract: BACKGROUND
  Blacks are less likely than whites to receive coronary revascularization and evidence-based therapies after acute myocardial infarction, yet the impact of these differences on long-term outcomes is unknown.
  
  
  RESULTS
  We linked Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of American College of Cardiology/American Heart Association Guidelines (CRUSADE) registry data to national Medicare claims, creating a longitudinal record of care and outcomes among 40 500 patients with non-ST-segment-elevation myocardial infarction treated at 446 hospitals to examine mortality and readmission rates (mean follow-up, 2.4 years) among black and white patients. Relative to whites (n=37 384), blacks (n=3116) were more often younger and female; more often had diabetes mellitus and renal failure; and received less aggressive interventions, including cardiac catheterization (60.7% versus 54.0%; P<0.001), percutaneous coronary intervention (32.1% versus 23.8%; P<0.001), and coronary bypass surgery (9.2% versus 5.7%; P<0.001). Although blacks had lower 30-day mortality (9.1% versus 9.9%; adjusted hazard ratio, 0.80; 95% confidence interval, 0.71-0.92), they had higher observed mortality at 1 year (27.9% versus 24.5%; P<0.001), although this was not significant after adjustment on long-term follow-up (hazard ratio, 1.00; 95% confidence interval, 0.94-1.07). Black patients also had higher 30-day (23.6% versus 20.0%; P<0.001) and 1-year (62.0% versus 54.6%; P<0.001) all-cause readmission, but these differences were no longer significant after risk adjustment on 30-day (hazard ratio, 1.02; 95% confidence interval, 0.92-1.13) and long-term (hazard ratio, 1.05; 95% confidence interval, 1.00-1.11) follow-up.
  
  
  CONCLUSIONS
  Although older blacks with an acute myocardial infarction had lower initial mortality rates than whites, this early survival advantage did not persist during long-term follow-up. The reasons for this are multifactorial but may include differences in comorbidities and postdischarge care.
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.M., A.Y.C., L.T., T.Y.W., K.L.T., M.T.R., E.D.P.); and National Heart Centre Singapore, Singapore (C.T.C.).
authors.forename: Robin
authors.initials: R
authors.lastname: Mathews
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.M., A.Y.C., L.T., T.Y.W., K.L.T., M.T.R., E.D.P.); and National Heart Centre Singapore, Singapore (C.T.C.).
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Chen
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.M., A.Y.C., L.T., T.Y.W., K.L.T., M.T.R., E.D.P.); and National Heart Centre Singapore, Singapore (C.T.C.).
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.M., A.Y.C., L.T., T.Y.W., K.L.T., M.T.R., E.D.P.); and National Heart Centre Singapore, Singapore (C.T.C.).
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.M., A.Y.C., L.T., T.Y.W., K.L.T., M.T.R., E.D.P.); and National Heart Centre Singapore, Singapore (C.T.C.).
authors.forename: Chee Tang
authors.initials: CT
authors.lastname: Chin
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.M., A.Y.C., L.T., T.Y.W., K.L.T., M.T.R., E.D.P.); and National Heart Centre Singapore, Singapore (C.T.C.).
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Thomas
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.M., A.Y.C., L.T., T.Y.W., K.L.T., M.T.R., E.D.P.); and National Heart Centre Singapore, Singapore (C.T.C.).
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.M., A.Y.C., L.T., T.Y.W., K.L.T., M.T.R., E.D.P.); and National Heart Centre Singapore, Singapore (C.T.C.). Peter016@mc.duke.edu.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D000789:Angina, Unstable / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality; D044383:Black People / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D015897:Comorbidity; D042241:Early Diagnosis; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007348:Insurance, Health / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality; D010359:Patient Readmission / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: continental population groups; healthcare disparities; myocardial infarction; patient outcome assessment