Impact of availability of hospital-based invasive cardiac services on racial differences in the use of these services

Background Reports indicate thai black patients ore less likely than white patients to receive invasive cardiac services after hospitalization for acu te myocardial infarction (AMI). There is still uncertainty as to why racial differences exist and how they affect patient outcomes. This is the first study to focus on the availability of invasive cardiac services and racial differences in procedure use. Study objectives were to (1) document whether racial differences existed in the use of invasive cardiac procedures, (2) study whether these racial differences were related to availability of hosp ital-based invasive cardiac services at First admission for AMI, and (3) de termine whether there were racial differences in long-term mortality rates. Methods A historical cohort study was conducted with discharge records from all acute care hospitals in New Jersey For 1993 linked to death certificat e records for 1993 and 1994. There were 13,690 black and white New Jersey r esidents hospitalized with primary diagnosis of AMI. Use of cardiac cathete rization within 90 days, revascularization within 90 days (percutaneous tra nsluminal coronary angioplasty [PTCA] or coronary artery bypass graft surge ry [CABG]), and death within 1 year after admission for AMI were the main o utcome measures. Patterns for PTCA and CABG as separate outcomes were also studied. Hospital-based cardiac services available were described as no inv asive cardiac services, catheterization only, or PTCA/CABG. To account for payer status and comorbidity differences, patients 65 years and older with Medicare coverage were analyzed separately from those younger than 65 years . Results slack patients aged 65 and older were generally less likely to rece ive catheterization and revascularization than white patients, regardless o f facilities available at first admission. For patients younger than 65 yea rs, the greatest differences between black and white patients in catheteriz ation and PTCA/CABG use within 90 days after AMI occurred when no hospital- based invasive cardiac services were available. However, use of invasive ca rdiac procedures within 90 days after AM I was substantially increased if t he first hospital offered catheterization only or PTCA/CABG services, among all patients, especially among blacks younger than age 65. No significant racial differences or interactions with available services were found in 1- year mortality rates. Conclusions Availability of invasive cardiac services at first hospitalizat ion for AMI was associated with increased procedure use for both races. How ever, use of invasive cardiac procedures was generally lower for black pati ents than for white patients, regardless of services available. long-term m ortality rates after hospitalization for AMI did not differ between blocks and whites.