The association between patient race, treatment, and outcomes of patients undergoing contemporary percutaneous coronary intervention: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)

The aim of this study was to examine if racial disparities exist in the treatment and outcomes of patients undergoing contemporary percutaneous coronary intervention (PCI). We examined the association between race, process of care, and outcomes of patients undergoing PCI between January 1, 2010, and...

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Vydané v:	The American heart journal Ročník 165; číslo 6; s. 893 - 901.e2
Hlavní autori:	Khambatta, Sherezade, Seth, Milan, Rosman, Howard S., Share, David, Aronow, Herbert D., Moscucci, Mauro, LaLonde, Thomas, Dixon, Simon R., Gurm, Hitinder S.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Mosby, Inc 01.06.2013 Elsevier Limited
Predmet:	African Americans Aged Blue Cross Blue Shield Insurance Plans Cardiovascular Cardiovascular disease Clinical outcomes Continental Population Groups Coronary Artery Disease - economics Coronary Artery Disease - ethnology Coronary Artery Disease - surgery Coronary vessels European Continental Ancestry Group Female Follow-Up Studies Heart attacks Heart failure Humans Hypotheses Logistics Male Michigan - epidemiology Middle Aged Morbidity - trends Mortality Outcome Assessment (Health Care) Percutaneous Coronary Intervention - economics Percutaneous Coronary Intervention - methods Propensity Score Registries Retrospective Studies Socioeconomic factors Survival Rate - trends Variables Michigan
ISSN:	0002-8703, 1097-6744, 1097-6744
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Abstract	The aim of this study was to examine if racial disparities exist in the treatment and outcomes of patients undergoing contemporary percutaneous coronary intervention (PCI). We examined the association between race, process of care, and outcomes of patients undergoing PCI between January 1, 2010, and December 31, 2011, and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. We used propensity matching to compare the outcome of black and white patients. The study cohort comprised 65,175 patients, of whom 6,873 (10.5%) were black and 55,789 (85.6%) were white. Black patients were more likely to be younger, be female, have more comorbidities, and be uninsured. Overall, black patients were less likely to receive prasugrel (10.0% vs 14.5%, P < .001) and drug-eluting stents (62.5% vs 67.7%, P < .001), largely related to lower use of these therapies in hospitals treating a higher proportion of black patients. No differences were seen between white and black patients with regard to inhospital mortality (odds ratio 1.34, 95% CI 0.82-2.2, P = .24), contrast-induced nephropathy (OR 1.06, 95% CI 0.81-1.40, P = .67), and need for transfusion (OR 1.27, 95% CI 0.98-1.64, P = .06). White race was associated with increased odds of heart failure (OR 1.48, 95% CI 1.05-2.08, P = .024) and vascular complications (OR 1.40, 95% CI 1.03-1.90, P = .032). Compared with white patients, black patients undergoing PCI have a greater burden of comorbidities but, after adjusting for these differences, have similar inhospital survival and lower odds of vascular complications and heart failure after PCI.
AbstractList	The aim of this study was to examine if racial disparities exist in the treatment and outcomes of patients undergoing contemporary percutaneous coronary intervention (PCI). We examined the association between race, process of care, and outcomes of patients undergoing PCI between January 1, 2010, and December 31, 2011, and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. We used propensity matching to compare the outcome of black and white patients. The study cohort comprised 65,175 patients, of whom 6,873 (10.5%) were black and 55,789 (85.6%) were white. Black patients were more likely to be younger, be female, have more comorbidities, and be uninsured. Overall, black patients were less likely to receive prasugrel (10.0% vs 14.5%, P < .001) and drug-eluting stents (62.5% vs 67.7%, P < .001), largely related to lower use of these therapies in hospitals treating a higher proportion of black patients. No differences were seen between white and black patients with regard to inhospital mortality (odds ratio 1.34, 95% CI 0.82-2.2, P = .24), contrast-induced nephropathy (OR 1.06, 95% CI 0.81-1.40, P = .67), and need for transfusion (OR 1.27, 95% CI 0.98-1.64, P = .06). White race was associated with increased odds of heart failure (OR 1.48, 95% CI 1.05-2.08, P = .024) and vascular complications (OR 1.40, 95% CI 1.03-1.90, P = .032). Compared with white patients, black patients undergoing PCI have a greater burden of comorbidities but, after adjusting for these differences, have similar inhospital survival and lower odds of vascular complications and heart failure after PCI. Background The aim of this study was to examine if racial disparities exist in the treatment and outcomes of patients undergoing contemporary percutaneous coronary intervention (PCI). Methods We examined the association between race, process of care, and outcomes of patients undergoing PCI between January 1, 2010, and December 31, 2011, and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. We used propensity matching to compare the outcome of black and white patients. Results The study cohort comprised 65,175 patients, of whom 6,873 (10.5%) were black and 55,789 (85.6%) were white. Black patients were more likely to be younger, be female, have more comorbidities, and be uninsured. Overall, black patients were less likely to receive prasugrel (10.0% vs 14.5%, P < .001) and drug-eluting stents (62.5% vs 67.7%, P < .001), largely related to lower use of these therapies in hospitals treating a higher proportion of black patients. No differences were seen between white and black patients with regard to inhospital mortality (odds ratio 1.34, 95% CI 0.82-2.2, P = .24), contrast-induced nephropathy (OR 1.06, 95% CI 0.81-1.40, P = .67), and need for transfusion (OR 1.27, 95% CI 0.98-1.64, P = .06). White race was associated with increased odds of heart failure (OR 1.48, 95% CI 1.05-2.08, P = .024) and vascular complications (OR 1.40, 95% CI 1.03-1.90, P = .032). Conclusions Compared with white patients, black patients undergoing PCI have a greater burden of comorbidities but, after adjusting for these differences, have similar inhospital survival and lower odds of vascular complications and heart failure after PCI. The aim of this study was to examine if racial disparities exist in the treatment and outcomes of patients undergoing contemporary percutaneous coronary intervention (PCI).BACKGROUNDThe aim of this study was to examine if racial disparities exist in the treatment and outcomes of patients undergoing contemporary percutaneous coronary intervention (PCI).We examined the association between race, process of care, and outcomes of patients undergoing PCI between January 1, 2010, and December 31, 2011, and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. We used propensity matching to compare the outcome of black and white patients.METHODSWe examined the association between race, process of care, and outcomes of patients undergoing PCI between January 1, 2010, and December 31, 2011, and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. We used propensity matching to compare the outcome of black and white patients.The study cohort comprised 65,175 patients, of whom 6,873 (10.5%) were black and 55,789 (85.6%) were white. Black patients were more likely to be younger, be female, have more comorbidities, and be uninsured. Overall, black patients were less likely to receive prasugrel (10.0% vs 14.5%, P < .001) and drug-eluting stents (62.5% vs 67.7%, P < .001), largely related to lower use of these therapies in hospitals treating a higher proportion of black patients. No differences were seen between white and black patients with regard to inhospital mortality (odds ratio 1.34, 95% CI 0.82-2.2, P = .24), contrast-induced nephropathy (OR 1.06, 95% CI 0.81-1.40, P = .67), and need for transfusion (OR 1.27, 95% CI 0.98-1.64, P = .06). White race was associated with increased odds of heart failure (OR 1.48, 95% CI 1.05-2.08, P = .024) and vascular complications (OR 1.40, 95% CI 1.03-1.90, P = .032).RESULTSThe study cohort comprised 65,175 patients, of whom 6,873 (10.5%) were black and 55,789 (85.6%) were white. Black patients were more likely to be younger, be female, have more comorbidities, and be uninsured. Overall, black patients were less likely to receive prasugrel (10.0% vs 14.5%, P < .001) and drug-eluting stents (62.5% vs 67.7%, P < .001), largely related to lower use of these therapies in hospitals treating a higher proportion of black patients. No differences were seen between white and black patients with regard to inhospital mortality (odds ratio 1.34, 95% CI 0.82-2.2, P = .24), contrast-induced nephropathy (OR 1.06, 95% CI 0.81-1.40, P = .67), and need for transfusion (OR 1.27, 95% CI 0.98-1.64, P = .06). White race was associated with increased odds of heart failure (OR 1.48, 95% CI 1.05-2.08, P = .024) and vascular complications (OR 1.40, 95% CI 1.03-1.90, P = .032).Compared with white patients, black patients undergoing PCI have a greater burden of comorbidities but, after adjusting for these differences, have similar inhospital survival and lower odds of vascular complications and heart failure after PCI.CONCLUSIONSCompared with white patients, black patients undergoing PCI have a greater burden of comorbidities but, after adjusting for these differences, have similar inhospital survival and lower odds of vascular complications and heart failure after PCI.
Author	Aronow, Herbert D. Rosman, Howard S. LaLonde, Thomas Seth, Milan Moscucci, Mauro Gurm, Hitinder S. Dixon, Simon R. Khambatta, Sherezade Share, David
Author_xml	– sequence: 1 givenname: Sherezade surname: Khambatta fullname: Khambatta, Sherezade organization: The Department of Cardiology, St John Hospital and Medical Center, Detroit, MI – sequence: 2 givenname: Milan surname: Seth fullname: Seth, Milan organization: Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI – sequence: 3 givenname: Howard S. surname: Rosman fullname: Rosman, Howard S. organization: The Department of Cardiology, St John Hospital and Medical Center, Detroit, MI – sequence: 4 givenname: David surname: Share fullname: Share, David organization: Blue Cross Blue Shield of Michigan, Detroit, MI – sequence: 5 givenname: Herbert D. surname: Aronow fullname: Aronow, Herbert D. organization: St Joseph Mercy Hospital, Ann Arbor, MI – sequence: 6 givenname: Mauro surname: Moscucci fullname: Moscucci, Mauro organization: Department of Medicine, University of Miami, Miami, FL – sequence: 7 givenname: Thomas surname: LaLonde fullname: LaLonde, Thomas organization: The Department of Cardiology, St John Hospital and Medical Center, Detroit, MI – sequence: 8 givenname: Simon R. surname: Dixon fullname: Dixon, Simon R. organization: Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI – sequence: 9 givenname: Hitinder S. surname: Gurm fullname: Gurm, Hitinder S. email: hgurm@med.umich.edu organization: Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI
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Snippet	The aim of this study was to examine if racial disparities exist in the treatment and outcomes of patients undergoing contemporary percutaneous coronary... Background The aim of this study was to examine if racial disparities exist in the treatment and outcomes of patients undergoing contemporary percutaneous...
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SubjectTerms	African Americans Aged Blue Cross Blue Shield Insurance Plans Cardiovascular Cardiovascular disease Clinical outcomes Continental Population Groups Coronary Artery Disease - economics Coronary Artery Disease - ethnology Coronary Artery Disease - surgery Coronary vessels European Continental Ancestry Group Female Follow-Up Studies Heart attacks Heart failure Humans Hypotheses Logistics Male Michigan - epidemiology Middle Aged Morbidity - trends Mortality Outcome Assessment (Health Care) Percutaneous Coronary Intervention - economics Percutaneous Coronary Intervention - methods Propensity Score Registries Retrospective Studies Socioeconomic factors Survival Rate - trends Variables
Title	The association between patient race, treatment, and outcomes of patients undergoing contemporary percutaneous coronary intervention: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)
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