Care and outcomes of asian-American acute myocardial infarction patients: Findings from the american heart association get with the guidelines-coronary artery disease program

Feng Qian, Frederick S. Ling, Prakash Deedwania, Adrian F. Hernandez, Gregg C. Fonarow, Christopher P. Cannon, Eric D. Peterson, W. Frank Peacock, Lisa A. Kaltenbach, Warren K. Laskey, Lee H. Schwamm, Deepak L. Bhatt

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

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. 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.

Original languageEnglish (US)
Pages (from-to)126-133
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume5
Issue number1
DOIs
StatePublished - Jan 2012
Externally publishedYes

Keywords

  • Acute myocardial infarction
  • Asian-Americans
  • Outcomes
  • Quality of care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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