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African-American heart attack patients fare worse long term

DURHAM, N.C. -- In the largest analysis of its kind, researchers from the Duke Clinical Research Institute (DCRI) found that African-American heart attack patients have a 1.7 times higher death rate than Caucasians one year after being treated in the hospital.

The researchers also found that while mortality rates within the first 30 days after treatment were similar between the two ethnic groups, African-Americans were more likely to suffer a major bleeding event or a stroke.

Importantly, differences between Caucasians and African-Americans in terms of patient characteristics and cardiovascular risk factors accounted for only a portion of the disparity in long-term mortality outcomes, according to Duke cardiologist Rajendra Mehta, M.D.

"No matter what patient or treatment feature we adjusted for statistically, this disparity in long-term outcomes still remained," said Mehta, who presented the results of the Duke analysis Nov.9, 2004, at the American Heart Association's annual scientific sessions in New Orleans.

"There has to be something else going on that we don't fully understand," Mehta said. "In order to improve the outcomes for African-American heart attack patients, we feel that there should be prospective clinical study to help us understand what these factors may be and how best to address them."

While the current analysis was not designed to uncover the reasons for these differences, behind, Mehta said he suspects a combination of socio-economic factors, including compliance with long-term drug therapy, mistrust of the medical system, and lack of medical insurance.

According to Mehta, health professionals have assumed African-Americans with coronary artery disease suffer worse outcomes because of their higher prevalence of risk factors, such as hypertension and diabetes, delays in seeking care, lower quality of care and access issues.

However, most studies addressing these questions have involved smal
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Contact: Richard Merritt
Merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
9-Nov-2004


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