CHEST 2024 Posters Reveal Disparities in Acute Coronary Syndrome Care, Outcomes

Two posters presented last week at the CHEST 2024 annual meeting in Boston, Massachusetts, highlighted disparities in acute coronary syndrome (ACS) care and outcomes among different racial, ethnic, and gender groups.

ACS refers to conditions characterized by poor blood flow to the heart, with most cases caused by a blocked blood vessel¹; because of this blockage, the heart does not receive enough blood or oxygen. Risk factors include high blood pressure, diabetes, and high cholesterol.

ACS Management Disparities During the COVID-19 Pandemic

The first poster analyzed the ACS management landscape during the COVID-19 pandemic, focusing on disparities among different racial, ethnic, and gender cohorts.² The researchers explained that disparities have long been recognized in cardiovascular care but were exacerbated by the COVID-19 pandemic; it affected the management of various medical conditions, including ACS.

Therefore, they conducted a retrospective cohort study using data from the National Inpatient Sample (NIS) between January 2020 and December 2020, the height of the COVID-19 pandemic. Using International Classification of Diseases (ICD) codes, they identified 95,420 patients admitted with ACS.

Among this study population, Black patients exhibited a significantly higher rate of in-hospital mortality than White patients (OR, 5.5; 95% CI, 5.2-5.9). As for ethnic groups, Hispanic patients had prolonged hospital stays, with an average duration of 7.2 days compared with 6.1 days among other racial and ethnic cohorts (P < .05). Lastly, in terms of gender disparities, women were less likely to undergo crucial diagnostic interventions, like coronary angiography, than men (OR, 0.7; 95% CI, 0.6-0.9).

The researchers noted that these findings emphasize the need for targeted interventions to address health care disparities, especially during a public health crisis. Therefore, they suggested that health care systems prioritize initiatives that promote equitable access to timely and comprehensive care; doing so may help ensure optimal clinical outcomes for all demographic groups.

“By fostering a more inclusive and equitable health care environment, clinicians and policymakers can strive towards achieving health care equity, thereby improving the overall health and wellbeing of populations affected by ACS and other cardiovascular conditions,” the authors concluded.

Predictors of Mortality Among Hospitalized Female Patients With ACS

Building upon the previous poster’s findings that women are less likely to receive guideline-directed interventions, the second poster examined the predictors of mortality among hospitalized female patients with ACS.³

Despite the extensive literature on the condition, the researchers highlighted a notable gap in the factors influencing the outcomes of women with ACS. Therefore, with data from the NIS (2016-2020), they used multivariate logistic regression models to examine the factors associated with mortality among hospitalized female patients with ACS.

In the adjusted analysis, the researchers determined that female patients who were 65 years or older (adjusted OR [aOR], 3.46; 95% CI, 2.91-4.11) and hospitalized for more than 5 days (aOR, 2.52; 95% CI, 2.01-2.98) had higher odds of mortality than their counterparts. As for race/ethnicity, non-Hispanic Black patients were more likely to die than non-Hispanic White patients (aOR, 1.54; 95% CI, 1.22-1.77).

Additionally, patients with private insurance were 16% less likely to die than Medicare beneficiaries (aOR, 0.84; 95% CI, 0.78-0.90). However, compared with Medicare beneficiaries, those with “other” insurance had higher odds of mortality (aOR, 1.33; 95% CI, 1.17-1.50). Lastly, the researchers found that patients hospitalized electively had lower odds of mortality than those hospitalized nonelectively (aOR, 0.52; 95% CI, 0.21-0.77).

"These findings emphasize the importance of a holistic and patient-centric approach in the management of female ACS patients, considering not only clinical factors but also social determinants of health,” the authors concluded.

Overall, both posters highlight disparities in ACS care and outcomes among specific demographic groups, noting higher mortality rates among Black patients, longer hospital stays for Hispanic patients, and reduced diagnostic interventions for female patients, with older age and nonelective hospital admissions recognized as key mortality predictors among the last group.

References

1. Fanaroff AC, Rymer JA, Goldstein SA. Acute coronary syndrome. JAMA. 2015;314(18):1990. doi:10.1001/jama.2015.12743
2. Nair A, Bolaji O, Zonshayn D, Desai D, Cheriyath P, Okere A. Racial, ethnic, and gender disparities among patients with acute coronary syndrome in the setting of COVID-19: a nationwide analysis. Poster presented at: CHEST Annual Meeting 2024; October 6-9, 2024; Boston, MA. doi:10.1016/j.chest.2024.06.259
3. Etuk A, George L, Suliman M, Sayyed RT. Predictors of mortality among hospitalized female patients with acute coronary syndrome. Poster presented at: CHEST Annual Meeting 2024; October 6-9, 2024; Boston, MA. doi:10.1016/j.chest.2024.06.394