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April 20, 1994

Racial Variation in Cardiac Procedure Use and Survival Following Acute Myocardial Infarction in the Department of Veterans Affairs

Author Affiliations

From Health Services Research and Development, Department of Medicine, Brockton/West Roxbury Veterans Affairs Medical Center, West Roxbury, Mass (Drs Peterson, Daley, Thibault, and Mr Wright); Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (Dr Peterson); Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory, Harvard Medical School, Boston, Mass (Dr Daley); and the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Dr Thibault).

JAMA. 1994;271(15):1175-1180. doi:10.1001/jama.1994.03510390045028

Objective.  —To examine whether blacks admitted to Veterans Affairs Medical Centers (VAMCs) with an acute myocardial infarction (AMI) are less likely than whites to undergo cardiac catheterization or coronary revascularization procedures and to determine the impact of these differences on patient survival.

Design.  —A retrospective observational study of inpatient discharge abstracts from the Veterans Health Administration (VHA).

Setting.  —All one hundred fifty-eight acute care hospitals in the VHA.

Patient Population.  —Male veterans (n=33 641) discharged from VAMCs with an International Classification of Diseases, Ninth Revision, Clinical Modification code for AMI from January 1, 1988, to December 31, 1990.

Intervention.  — None.

Main Outcome Measures.  —The use of cardiac catheterization, coronary angioplasty, and/or bypass surgery in the 90 days after admission for AMI, and survival at 30 days, 1 year, and 2 years.

Main Results.  —Adjusting for patient and hospital characteristics, blacks with an AMI were 33% less likely than whites to undergo cardiac catheterization, 42% less likely to receive coronary angioplasty, and 54% less likely to receive coronary bypass surgery. Among patients who underwent catheterization, blacks were also less likely than whites to have a subsequent cardiac revascularization procedure. Adjusted 30-day survival for blacks was significantly greater than for whites. One- and 2-year survival rates after AMI were not significantly different between blacks and whites.

Conclusions.  —In a health care system designed to provide equivalent availability of care to all eligible patients, blacks received substantially fewer cardiac procedures after AMI than whites. Despite undergoing fewer interventional procedures, blacks had better short-term and equivalent intermediate survival rates compared with whites.(JAMA. 1994;271:1175-1180)