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    Study Finds Inequality in Heart Attack Treatments


    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.

    Curry says that some of the therapy gap may be attributed to the differences in symptoms that blacks and women experience when having a heart attack, which could lead to delays or misdiagnoses by their doctors. But that doesn't explain the glaring failure to send heart attack survivors home with the appropriate drugs. "That is very hard to explain," he says.

    There may be other factors leading to this underuse of therapies. "There is at least the suspicion that racial and ethnic minorities come with certain preconceptions about health care and about the likelihood of these patients adhering to a medical regimen," Charles K. Francis, MD, tells WebMD. "These preconceptions can influence treatment decisions." Francis is president of Charles R. Drew University in Los Angeles and a spokesman for the American Heart Association.

    He says, too, that some of these findings may be attributed to the fact that doctors, in general, are "slow to implement guidelines," and the guidelines for aspirin and beta-blocker use are fairly recent. "What may be happening is that as the physicians begin to implement the guidelines, they focus initially on the group that is most at risk: older, white men," Francis says.

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