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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1033 — Disparity in Coronary Interventions in Patients Admitted to VA Hospitals without Revascularization

Author List:
Popescu IS (VA Medical Center and University of Iowa College of Medicine, Iowa City IA)
Vaughn Sarrazin MS (VA Medical Center and University of Iowa College of Medicine, Iowa City IA)
Rosenthal GE (VA Medical Center and University of Iowa College of Medicine, Iowa City IA)

Objectives:
While prior studies have examined racial differences in the use of coronary revascularization after acute myocardial infarction (AMI), few studies have compared patterns of care for AMI patients in the majority of Veterans Health Administration (VHA) hospitals that do not perform revascularization. This study compared rates of transfer and revascularization following AMI in black and white patients admitted to VHA hospitals without revascularization.

Methods:
The VHA Patient Treatment File (PTF) identified all black and white patients, 65 years or older, with a primary diagnosis of AMI during 1998-2002 (n= 10,327) in 126 VHA facilities without revascularization. For each patient, PTF and Medicare Part A data were used to ascertain subsequent transfers to VHA and private sector hospitals with revascularization, and revascularization within 30 days with either coronary bypass surgery (CABG) or percutaneous coronary intervention (PCI). Hierarchical models adjusted for socioeconomic and clinical risk factors, and distances to the nearest VHA and private sector hospitals with revascularization.

Results:
Blacks were less likely (p<.001) to be transferred to a VHA (10.5% vs. 14.8%) or private sector (1.3% vs. 3.9%) hospital with revascularization. Blacks were also less likely to undergo revascularization at any hospital within 30 days (9.4% vs. 16.4%, p<.001). Among patients who were transferred, blacks were still somewhat less likely to undergo revascularization (45.5% vs. 53.4%, p=.07). After adjusting for demographics, socioeconomic status, clinical factors and distance, blacks remained less likely to be transferred (OR 0.71, 95%CI 0.52-0.90, p = .0014) and undergo revascularization within 30 days (OR 0.53, 95%CI 0.26-0.80, p<.001). Among patients who were transferred, blacks were also less likely to undergo revascularization within 30 days (OR 0.54, 95%CI 0.31-0.77, p<.001).

Implications:
Black patients with AMI admitted to VHA hospitals without coronary revascularization were less likely to be transferred to VHA or private sector hospitals with revascularization services, and to undergo subsequent revascularization within 30 days of AMI admission.

Impacts:
Differential patient transfer patterns may be an important source of racial disparity. Future research is needed to determine if the differential rates reflect medical decision making or patient preferences.


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