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Titolo:
RACIAL-DIFFERENCES IN THE MEDICAL-TREATMENT OF ELDERLY MEDICARE PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION
Autore:
ALLISON JJ; KIEFE CI; CENTOR RM; BOX JB; FARMER RM;
Indirizzi:
UNIV ALABAMA,SCH MED,DIV GEN INTERNAL MED,621 MED EDUC BLDG,1813 6TH AVE S BIRMINGHAM AL 35294
Titolo Testata:
Journal of general internal medicine
fascicolo: 12, volume: 11, anno: 1996,
pagine: 736 - 743
SICI:
0884-8734(1996)11:12<736:RITMOE>2.0.ZU;2-0
Fonte:
ISI
Lingua:
ENG
Soggetto:
TRANSLUMINAL CORONARY ANGIOPLASTY; BYPASS GRAFT-SURGERY; CARDIOVASCULAR PROCEDURES; HEALTH-CARE; BLACK; RATES; METAANALYSIS; INTERVENTION; THROMBOLYSIS; SYMPTOMS;
Keywords:
MEDICARE PATIENTS; ELDERLY PATIENTS; ACUTE MYOCARDIAL INFARCTION; RACIAL DIFFERENCES IN TREATMENT;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
25
Recensione:
Indirizzi per estratti:
Citazione:
J.J. Allison et al., "RACIAL-DIFFERENCES IN THE MEDICAL-TREATMENT OF ELDERLY MEDICARE PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION", Journal of general internal medicine, 11(12), 1996, pp. 736-743

Abstract

OBJECTIVE: To compare the use of medications in African-American and Caucasian elderly Medicare patients hospitalized with acute myocardialinfarction (AMI) in Alabama. DESIGN: Retrospective medical record review. SETTING: All acute care hospitals in Alabama. PATIENTS: All Medicare patients with a principal discharge diagnosis of AMI from June 1992 through February 1993. We excluded those patients less than 65 yearsof age and those of ethnicity other than African-American or Caucasian (N = 4,052). MEASUREMENTS: We first performed a crude analysis usingall cases to compare by race the use of thrombolysis, p-adrenergic blockade, and aspirin in the setting of AMI. In addition, we developed amultivariable model with receipt of therapy as the outcome and demographics, severity of illness, comorbidity, and algorithm-determined candidacy for therapy as covariates. The algorithms, developed as part ofthe Cooperative Cardiovascular Project, were designed to identify an ''ideal'' pool of candidates for each therapy. MAIN RESULTS: For all cases, 9.2% (95% confidence interval [CI] 6.8, 12.1) of African Americans received thrombolysis compared with 17.3% (95% CI 16.0, 18.6) of Caucasians. Approximately 16.4% of patients received p-adrenergic blockade, and 45.1% received aspirin, both with no racial difference. By multivariate analysis, the adjusted odds ratio for African Americans receiving thrombolysis was 0.55 (95% CI 0.41, 0.76). The corresponding odds ratio was 1.25 (95% CI 0.99, 1.59) for beta-adrenergic blockade and 1.13 (95% CI 0.96, 1.37) for aspirin. African Americans presented later after the onset of chest pain, but the refusal rate of thrombolytic therapy did not differ. CONCLUSIONS: According to this analysis, Alabama physicians used beta-adrenergic blockade and aspirin equivalently in African Americans and Caucasians. African Americans received thrombolysis less often according to the crude analysis. The multivariable analysis suggests less use of thrombolytics, even after adjusting for several covariates including indication by clinical algorithm. However, the small number of African-American patients deemed ideal candidates for thrombolysis attenuates the precision of this finding.

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Documento generato il 16/07/20 alle ore 05:35:53