TY - JOUR
T1 - Care and outcomes of asian-American acute myocardial infarction patients
T2 - Findings from the american heart association get with the guidelines-coronary artery disease program
AU - Qian, Feng
AU - Ling, Frederick S.
AU - Deedwania, Prakash
AU - Hernandez, Adrian F.
AU - Fonarow, Gregg C.
AU - Cannon, Christopher P.
AU - Peterson, Eric D.
AU - Peacock, W. Frank
AU - Kaltenbach, Lisa A.
AU - Laskey, Warren K.
AU - Schwamm, Lee H.
AU - Bhatt, Deepak L.
PY - 2012/1
Y1 - 2012/1
N2 - 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. Methods and 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.
AB - 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. Methods and 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.
KW - Acute myocardial infarction
KW - Asian-Americans
KW - Outcomes
KW - Quality of care
UR - http://www.scopus.com/inward/record.url?scp=84860795517&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84860795517&partnerID=8YFLogxK
U2 - 10.1161/CIRCOUTCOMES.111.961987
DO - 10.1161/CIRCOUTCOMES.111.961987
M3 - Article
C2 - 22235068
AN - SCOPUS:84860795517
SN - 1941-7713
VL - 5
SP - 126
EP - 133
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 1
ER -