CLINICAL RESEARCH: ACUTE CORONARY SYNDROME
The Influence of Race on Health Status Outcomes One Year After an Acute Coronary Syndrome
John Spertus, MD, MPH*, , ,*,
David Safley, MD*,,,
Mukesh Garg, MD,,
Philip Jones, MS* and
Eric D. Peterson, MD, MPH
* Mid America Heart Institute of Saint Luke’s Hospital, Kansas City, Missouri
University of Missouri-Kansas City, Kansas City, Missouri
Truman Medical Center, Kansas City, Missouri
Duke University Medical Center, Durham, North Carolina.
Manuscript received January 22, 2005;
revised manuscript received April 25, 2005,
accepted May 2, 2005.
* Reprint requests and correspondence: Dr. John Spertus, Cardiovascular Education and Outcomes Research, Mid America Heart Institute, 4401 Wornall Road, Kansas City, Missouri 64111. (Email: spertusj{at}umkc.edu).
OBJECTIVES: The goal of this study was to compare health status (symptoms, function, and quality of life) outcomes of whites and blacks one year after an acute coronary syndrome (ACS).
BACKGROUND: Although racial differences in the use of angiography and revascularization after ACS are known to exist, differences in health status outcomes have not been described.
METHODS: We conducted a prospective registry of 1,159 consecutive ACS patients treated between February 1, 2000 and October 31, 2001. One-year health status was quantified with the Seattle Angina Questionnaire (SAQ) and Short Form-12 Physical Component Score (SF-12 PCS). Multivariable models were used to adjust for racial differences in sociodemographic, clinical, and treatment characteristics.
RESULTS: Mortality rates were similar among the 196 black and 963 white patients (7.1% vs. 7.0%, p = 0.93); 81 died during follow-up, and 199 (17%) could not be interviewed. At one year, blacks had a higher prevalence of angina (43.4% vs. 27.1%), worse quality of life (SAQ score = 70.6 ± 28.3 vs. 83.9 ± 20.8), and poorer physical function (SF-12 PCS = 36.8 ± 12.3 vs. 43.2 ± 11.4; p < 0.0001 for all). Multivariable models, including hospital treatments, revealed a trend for more angina (odds ratio 1.46 [95% confidence interval 0.91 to 2.34]) and significantly worse quality of life (mean difference = –7.7 ± 2.4, p = 0.002) and physical function (–3.6 ± 1.3, p = 0.005).
CONCLUSIONS: Blacks have more angina, worse quality of life, and worse physical function one year after an ACS than do whites. Closer surveillance of black ACS patients is needed to determine whether additional treatment can improve their outcomes.
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Abbreviations and Acronyms
| | ACS = acute coronary syndromes | | CABG = coronary artery bypass grafting | | MI = myocardial infarction | | PCI = percutaneous coronary intervention | | SAQ = Seattle Angina Questionnaire | | SF-12 PCS = Short Form-12 Physical Component Score | | VA = Veterans Affairs |
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