News | Heart Failure | May 23, 2022

Racial Disparities Seen in Treatment for Patients with Acute Coronary Syndrome and History of Cocaine Use

Nationwide study points to implicit bias in treatment of cardiovascular disease for non-Hispanic Black patients and highlights need for equity

Nationwide study points to implicit bias in treatment of cardiovascular disease for non-Hispanic Black patients and highlights need for equity

May 23, 2022 — Insights from a National Inpatient Sample Database examining race and the rates of cardiac catheterization or revascularization for acute coronary syndrome (ACS) patients with a history of cocaine use is being presented today at the Society for Cardiovascular Angiography & Interventions (SCAI) 2022 Scientific Sessions. The findings reveal rates of cardiac catheterization and revascularization were significantly lower in nonHispanic Black (NH Black) patients compared to white patients with ACS and cocaine use.

ACS is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart (AHA). The use of cocaine can cause coronary artery vasospasm, or a sudden narrowing of the artery, leading to myocardial ischemia, acute coronary syndrome and acute myocardial infarction (NLM). Current American Heart Association guidelines state that patients with a history of cocaine use diagnosed with ACS should be treated the same as non-use patients.

“We noticed in hospitals in Miami, rates of cardiac catheterization or revascularization, especially among cocaine users, was often a subjective decision based on a variety of factors and wanted to see if this was true on a national scale. We were motivated by our internal medicine program director, Dr. Stefanie Brown, and our research mentor, Dr. Rosario Colombo, to develop this research question,” said Michael Dangl, MD, resident at University of Miami and lead author of the study.

Researchers examined data from the National Inpatient Sample Database between 2011-2019 for relevant ICD-9 and ICD-10 procedural and diagnostic codes. Baseline characteristics and inhospital outcomes were compared between NH Black and White patients with a history of cocaine use and a primary admission diagnosis of ACS to determine if race was a factor in treatment. A multivariate logistic-regression was performed to adjust for age, sex, ST-elevation myocardial infarction, tobacco use and select co-morbidities for cardiac catheterization and revascularization.

The study identified 43,798 hospitalizations for patients with a history of cocaine use and ACS which were dichotamized into NH Black and white groups. 26,905 hospitalizations (61.4%) were for NH Black patients. NH Black patients had lower rates of cardiac catheterization (61.7% vs 72.5%) and revascularization (38.4% vs 52.1%), p<0.001 for all. The lower rates of cardiac catheterization and revascularization persisted after adjusting for potential confounding factors.

“We saw that NH Black patients with a history of cocaine use had a much lower rate of cardiac catheterization and revascularization compared to white patients who had a history of using cocaine,” said Jelani K. Grant, chief medical resident at the University of Miami and senior author of the study. “The results highlight a disparity that must be further investigated in this specific population, since a history of drug use and race should not affect whether to proceed with an invasive procedure that could potentially be lifesaving in the long term.”

“Our hope is this study raises awareness of implicit biases that potentially exists when treating patients for acute coronary syndrome. Now that our findings suggest this bias exists, we can work together to help achieve health equity by evaluating other social determinants of health which may be related to race and a history of cocaine use,” said Carlos Vergara, MD, resident at University of Miami and co-author of the study.

The authors expect to work with the community and other cardiologists to create actionable steps to help ensure health equity across all cardiovascular diseases and treatments regardless of race, socioeconomics, demographics or substance abuse history. The authors are presently collaborating with cardiologist, Dr. Rishi Wadhera, at the Beth Israel Deaconess Medical Center to complete the final manuscript.

For more information: www.scai.org

Find more SCAI22 coverage here

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