Clinical characteristics, process of care, and outcomes of Hispanic patients presenting with non–ST-segment elevation acute coronary syndromes: Results from Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE)
Received 29 June 2005; accepted 7 September 2005.
Background
Data regarding the management of non–ST-segment elevation acute coronary syndromes (NSTE ACS) in Hispanic patients, the largest and fastest-growing minority in the United States, are scarce.
Methods
We sought to describe the clinical characteristics, process of care, and outcomes of Hispanics presenting with NSTE ACS at US hospitals. We compared baseline characteristics, resource use, and inhospital mortality among 3936 Hispanics and 90280 non-Hispanic whites with NSTE ACS from the CRUSADE Quality Improvement Initiative.
Results
The regional distribution of Hispanics in CRUSADE paralleled that in the US Census. Hispanics were younger (65 vs 70 years, P < .0001) and had less hyperlipidemia (45.4% vs 49.0%, P < .0001) but were more likely to be hypertensive (72.2% vs 67.9%, P < .0001) and diabetic (46.5% vs 30.9%, P < .0001). Hispanics were also more likely to be uninsured (12.5% vs 5.1%, P < .001). During hospitalization, Hispanics were more often managed conservatively, undergoing stress tests more frequently (13.0% vs 10.1%, P < .0001), with less use of cardiac catheterization within 48 hours (48.7% vs 55.5%, P < .0001) or percutaneous coronary intervention (39.6% vs 46.4%, P < .0001) at any time. Hispanics received similar discharge treatments but were less frequently referred for cardiac rehabilitation (38.5% vs 49.2%, P < .0001). Adjusted inhospital mortality was similar in both groups (odds ratio 0.87, 95% CI 0.72-1.05).
Conclusions
Although hispanics have a different risk factor profile and are treated less aggressively during hospitalization when they present with NSTE ACS, these treatment differences do not appear to affect inhospital outcomes. Further research is warranted to explore the long-term consequences of these findings.
aDivision of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
cPittsburgh VA Health System and University of Pittsburgh, Pittsburgh, PA
dUniversity of Oklahoma Health Sciences Center, Oklahoma City, OK
ePennsylvania Hospital, University of Pennsylvania School of Medicine, Philadelphia, PA
fUniversity of Arkansas for Medical Sciences, Little Rock, AR
gDepartment of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
Reprint requests: Mauricio G. Cohen, MD, Division of Cardiology, University of North Carolina, 130 Mason Farm Road, CB #7075, Bioinformatics Building, Suite 4128, Chapel Hill, NC 27599-7075.
CRUSADE is a National Quality Improvement Initiative of the Duke Clinical Research Institute. CRUSADE is funded by Millennium Pharmaceuticals, Inc, Cambridge, Mass, and Schering Corporation, Kenilworth, NJ. Bristol-Myers Squibb (Plainsboro, NJ)/Sanofi Pharmaceuticals (New York, NY) Partnership provides additional support.
Guest editor of this manuscript is Morton J. Kern, MD.
ABSTRACT