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Dr. Sameer Arora

(Republished from the UNC Health Care and UNC School of Medicine Newsroom)

A new study published in the Journal of the American Heart Association shows disparities between the care given to black and white patients seeking treatment for a type of heart attack called NSTEMI (Non-ST-elevation myocardial infarction). Researchers found that black patients were less likely than white patients to receive aggressive treatment, or to be given certain types of medications commonly prescribed under current treatment guidelines. Racial differences in NSTEMI management have previously been reported, but researchers wanted to learn whether these disparities have been improved over time. They found there has been no substantial improvement in the disparities over the past 15 years.

Cardiology fellow Sameer Arora, MD, at the UNC School of Medicine and colleagues looked at data collected by the Atherosclerosis Risk in Community (ARIC) study, which included medical treatment records of nearly 18,000 weighted hospitalizations between 2000 and 2014. The researchers found that black patients were 29 percent less likely to get an angiogram, and 45 percent less likely to undergo more aggressive procedures like bypass surgery or angioplasty.

“It’s worrisome that we have differences in treatment in this day and age, and it’s even more concerning that we really have not seen a narrowing of these disparities over time,” said Arora.

Arora says one factor that may contribute to the difference in treatment is that black patients were more likely to have comorbidities — chronic illnesses such as diabetes or kidney disease — that made them higher-risk patients. The presence of comorbidities reduces the likelihood that a physician would want to pursue an aggressive treatment that could put the patient at further risk. However, Arora says that factor does not explain why black patients were less likely to be put on medications like aspirin, which are low-risk and part of treatment guidelines for heart attack patients.

“There are obviously more factors leading to these disparities, and possible inherent bias by physicians can’t be ruled out,” Arora said. “This study shows that a multi-faceted approach is needed to begin changing the way black patients receive treatment.”

Arora also says more focused efforts are needed on prevention to reduce comorbidities for black patients. The study, co-authored by UNC’s George Stouffer, MD, chief of the division of cardiology, and cardiovascular epidemiologist Melissa Caughey, PhD, suggests the need for population-based strategies including more outreach within communities to improve physical activity, diet, and smoking habits.