Racial disparities in acute coronary syndrome management within a universal healthcare context: Insights from the AMI-OPTIMA trial

Abstract

Abstract Background While prior studies have demonstrated racial disparities regarding acute coronary syndrome (ACS) care within private or mixed health care systems, few researchers have explored such disparities within universal healthcare systems. We aimed to evaluate the quality and outcomes of in-hospital ACS management between White patients and people of color within a universal healthcare context. Methods We performed a post-hoc analysis of the AMI-OPTIMA study, a cluster-randomized trial evaluating a knowledge translation intervention at 24 hospitals in Quebec, Canada (years: 2009 and 2012). The primary endpoint was coronary catheterization. The secondary endpoints included in-hospital mortality, percutaneous and surgical coronary revascularization, major bleeding, total stroke, and discharge prescription of evidence-based medical therapy. Results Of 3,444 included patients, 2,738 were White and 706 were people of color. The mean age was 68.2 years (33.3% women) among White patients and 69.5 years (36.0% women) among people of color. People of color were less likely to undergo in-hospital coronary catheterization than White patients (74.5% versus 80.3%, p-value 0.001). This difference was attenuated after adjusting for patient-level characteristics (OR 0.89, 95% CI 0.73–1.09) and eliminated after adjusting for hospital-level characteristics (OR 1.04, 95% CI 0.73–1.49). Conclusion Racial disparity in coronary catheterization for ACS persists within a universal healthcare context. Patients’ comorbidities and hospital-level factors may be partially responsible for this inequality. Future research on cardiovascular healthcare in patients with diverse racial/ethnic backgrounds in universal healthcare systems is needed to remediate racial inequality in ACS management.