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Study Finds Inequality in Heart Attack Treatments

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WebMD Health News

Aug. 7, 2000 -- Although many proven and relatively inexpensive therapies for heart attacks exist, a disturbing new study suggests that blacks, women, and the poor are far less likely than wealthier, white men to receive these lifesaving medicines.

This isn't the first study to indicate that white men have the edge in getting heart attack treatments. But it suggests that the preference goes far beyond high-tech procedures to open clogged arteries (such as angioplasty) and extends to other important therapies, some costing only pennies a day, such as aspirin or a class of drugs called beta-blockers.

The first few hours after a heart attack are critical to prevent permanent, often life-threatening damage to the heart. The American Heart Association recommends that an aspirin be given at the first sign of heart attack. It also recommends the use of clot-busting drugs within the first few hours, to minimize heart damage. Then, the AMA recommends that heart attack survivors be prescribed daily aspirin and beta-blockers, which studies have shown can prevent second heart attacks.

But according to this study of nearly 170,000 Medicare patients who had heart attacks, many heart attack victims are not getting these therapies. Blacks were 16% less likely than whites to receive clot-busting drugs, and were 3% less likely to receive aspirin on admission than white men. On their discharge from the hospital, blacks were 6% less likely to have a prescription for beta-blockers. Women were 2% less likely to receive aspirin on hospital admission or discharge, but got the other drugs at nearly the same rate as men. Patients from low-income areas were 2% to 3% less likely than others to get any of the recommended therapies, according to the study, published in Circulation: Journal of the American Heart Association.

In a statement released by the American Heart Association, study co-author Bernard J. Gersh, MD, ChB, DPhil, says: "The differences in treatment that we found are not huge, but they are significant."

Charles L. Curry, MD, agrees. "There have been numerous studies done in various settings, and they have all shown the same thing: Women, minorities, and the poor are less likely to receive more sophisticated care." Curry, who wasn't part of this study, is a professor of medicine at Howard University School of Medicine in Washington.

The findings, according to another study author, Kevin A. Schulman, MD, point to some significant issues. "What is unique about this [study] 1/4 is that when we looked specifically at inexpensive medications, we still see differences by race and gender that are pretty much inexplicable and suggest system failure." Schulman is an associate professor of medicine at Duke University Medical Center in Durham, N.C.

To explain these differences, Schulman says, "we have to go back to the concept of medical error. There are errors of commission and errors of omission. To some extent, what we are seeing may be errors of omission that suggest system failures. Because of budget cutbacks, there are fewer people to advocate for the poor and the minorities in a system." He says, for example, that reductions in hospital staff may result in less-comprehensive discharge planning, and mean that prescriptions for important drugs may not get written.

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