Process of Care, Use of Hospital Retypes is Different
DALLAS, TX -- Duke University Medical Center researchers found in a study
involving hospitals across the nation that Hispanics experienced a median
delay of nine minutes from the onset of heart attack symptoms until they
received medical therapy when compared with non-Hispanics. When they were
treated, Hispanics also received fewer invasive procedures, such as cardiac
catheterization and coronary by-pass surgery.
Despite the differences, the clinical outcomes of the 700-plus Hispanics
in the study were about the same as non-Hispanics, a finding researchers
suggest might be due in part to the younger age at which Hispanics
experience heart problems. The study findings were prepared for presentation
at a news conference at the 71st annual scientific sessions of the American Heart Association.
"Hispanics constitute the second largest, and fastest growing, minority
group in the U.S, yet this study tells us that the process of care for this
population is different," said researcher Dr. Mauricio Cohen, a cardiology
fellow at the Duke Clinical Research Institute. "This should be of concern
to the health care community since Hispanics historically have high risk
factors for heart disease, such as diabetes, obesity, and high
Language barriers on the part of both the patient and the health care
system, as well as possible differences in interpreting symptoms of heart
disease, likely account for the delays, said co-researcher Dr. Magnus Ohman.
"We think much there should be much more attention to ways to speed up
treatment for these patients."
Differences in the procedures used in treatment are probably not due to
differences in language or culture but to characteristics of the disease and
the person's risk factors, Ohman said. "Well-established clinical guidelines
determine how a disease is managed, not the language a person speaks."
Cohen added, however, that the insurance status of the patients may have
played some role in their care. Fewer Hispanics had private health
insurance, and more had no insurance, compared to non-Hispanics. "This may
have influenced physicians decisions in whether to use more aggressive
treatments, although the care Hispanics received was obviously adequate,
since outcomes were the same," he said.
The term "Hispanic" is a term coined 20 years ago by the U.S. government
to indicate a Spanish-speaking person. Hispanics represent a diverse ethnic
group that includes Mexican-Americans, Puerto Ricans, Cubans, Dominicans,
and others from Latin and South America. An Hispanic can be of any race.
The research team conducted the study because, not only are Hispanics the
fastest growing minority population, previous research has shown that this
group has a higher prevalence of cardiovascular risk factors, and that
socioeconomic factors such as poverty and limited access to health care may
influence the success of their treatment.
Researchers used prospectively gathered data from the GUSTO (Global
Utilization of Strategies to Open Occluded Coronary Arteries) clinical trial
to conduct the analysis. The GUSTO 1 trial enrolled more than 41,000
patients at 569 hospitals, and GUSTO III studied approximately 15,000
patients around the world, including patients at 299 U.S. hospitals. These
trials compared different strategies to dissolve blood clots in patients
having a heart attack.
The Hispanic portion of the study considered only patients in the United
States because the definition of Hispanic ethnicity likely varied in
different countries. Of the U.S. patients, 734 were Hispanic and 27,054 were
Among the statistically significant differences researchers found between
the two groups were:
Hispanics seeking treatment for heart attacks were, on average, three
years younger (58) compared to non-Hispanics (61 years old).
More Hispanics (26 percent) suffered from diabetes than non-Hispanics (17
percent). But more non-Hispanics (39 percent) had documented high
cholesterol than Hispanics (34 percent). There were no significant
differences between the groups in the number of patients that smoked (about
44 percent) and that had hypertension (also about 44 percent).
The location in the heart of the infarction was significantly different
between the groups. More Hispanics (43 percent) had anterior attacks, which
have a worse prognosis, than non-Hispanics (38 percent).
More non-Hispanics had private health insurance (63 percent) than
non-Hispanics (43 percent) and more Hispanics (18 percent) had no health
insurance, compared to non-Hispanics (6 percent).
Fewer Hispanics (47 percent) completed high school, compared to
non-Hispanics (73 percent).
More Hispanics were laborers (56 percent) compared to non-Hispanics (36
Fewer Hispanics lived alone (10 percent) compared to non-Hispanics (19
More non-Hispanics received a diagnostic catheterization (74 percent)
and/or by-pass surgery (13.5 percent) compared to Hispanics (70 percent and
11 percent, respectively).