When they suffer a heart attack, Black and Hispanic patients in the United States receive subpar care compared with white patients, new research reveals.
The study of more than 87,000 insured heart attack patients found that Black and Hispanic people were less likely to undergo angioplasty and stenting — procedures commonly used to assess and treat coronary artery blockage.
"As providers, we must be aware of our biases and treat patients to ensure health equity for all. More work must be done regarding the persistent racial and ethnic disparities in managing heart disease," said lead researcher Dr. Tarryn Tertulien. She is an internal medicine resident at the University of Pittsburgh Medical Center.
These disparities exist for many reasons, Tertulien said. "These include, but are not limited to, institutional racism, personal biases, lack of access to care and even fear of the medical system in the setting of prior experiences with discrimination," she said.
Social determinants — such as income, education and race — are also important factors of one's overall health, but Black patients with the same incomes as white patients still receive worse care, Tertulien said. "Race is a social construct and has been shown to be associated with coronary intervention, independent of socioeconomic status," she added.
The study looked at data on people who had a heart attack between 2017 and 2019. Their average age was 74. Insured Asian, Black, Hispanic and white patients were included.
The researchers found Black patients were 7% less likely to undergo coronary angiography and 14% less likely to have an angioplasty than white patients. Hispanics were 12% less likely to have an angiogram and 15% less likely to have an angioplasty than white patients.
No significant difference was seen between white and Asian patients for either procedure. Although all the patients had either private insurance or Medicare Advantage plans, poorer patients were less likely to have an angiogram or get a stent to keep a blocked artery open than wealthier patients, the researchers noted.
Withholding these treatments can have serious consequences, Tertulien said.
"Coronary angiography and stenting are lifesaving procedures, which are standard of care," she said.
Without appropriate and timely intervention, an untreated heart attack can result in severe irregular electrical rhythms of the heart, heart failure and even death, Tertulien said.
It's possible to overcome racial disparities in cardiac care, she noted.
"The first step is to acknowledge that racial disparities persist in managing heart attacks. Second, we must recognize that we all have personal biases. Lastly, policymakers need to incentivize health care systems to create a more equitable system," Tertulien added.
Dr. Robert Roswell is co-director of the cardiac intensive care unit at Lenox Hill Hospital in New York City. He said people have been aware of the disparities in health care between Black and white patients in the United States for many years.
"I think the basis of this study was to see whether the awareness of these disparities has moved us towards health equity and if these disparities would fade away. The results of the study show that they have not," he said.
Roswell said residential segregation drives a lot of these disparities. Black patients often have to go to hospitals that don't offer the highest quality of care, he noted.
"We're seeing the downstream consequences of what's going on with the structure and the policies, and the practice of how our country works," he said. "Society has to change structurally in terms of education and access, and resources have to change. Also, the demographic makeup of medicine has to change."
Roswell believes that having more Black doctors is one way to reduce prejudice. If white patients see more Black doctors, that might quell their bias and Black patients may feel more confident in the medical system, he noted.
"The more diverse your physician workforce is, I think we'll see health inequities begin to go down as well," Roswell said.
The report was published online recently in the Journal of the American Heart Association.
For more on racial disparities in medical care, head to the Century Foundation.
SOURCES: Tarryn Tertulien, MD, internal medicine resident, University of Pittsburgh Medical Center; Robert Roswell, MD, co-director, cardiac intensive care unit, Lenox Hill Hospital, New York City; Journal of the American Heart Association, June 14, 2022, online