Study Finds Racial Disparities in Treatment of Patients With Acute Coronary Syndrome, History of Cocaine Use

The use of cocaine can cause coronary artery vasospasm, which can lead to myocardial ischemia, acute coronary syndrome, and acute myocardial infarction.

A new nationwide study has found implicit bias in the treatment of cardiovascular disease among non-Hispanic Black patients, highlighting the need for greater equity in treatment protocols.

According to research presented at the Society for Cardiovascular Angiography and Interventions, rates of cardiac catheterization and revascularization were significantly lower in non-Hispanic Black patients compared to white patients with acute coronary syndrome (ACS) and a history of cocaine use. The data comes from a National Inpatient Sample Database examining race and the rates of cardiac catheterization or revascularization.

ACS describes a range of conditions associated with sudden, reduced blood flow to the heart. The use of cocaine can cause coronary artery vasospasm, or a sudden narrowing of the artery, which can lead to myocardial ischemia, acute coronary syndrome, and acute myocardial infarction. Current guidelines from the American Heart Association say that patients with a history of cocaine use diagnosed with ACS should be treated the same as patients with no history of cocaine use.

“We noticed in hospitals in Miami, rates of cardiac catheterization or revascularization, especially among cocaine users, was often a subjective decision based on a variety of factors and wanted to see if this was true on a national scale,” said lead author Michael Dangl, MD, a resident at the University of Miami, in a press release.

Investigators examined data from the National Inpatient Sample Database between 2011 and 2019 for relevant procedural and diagnostic codes. Baseline characteristics and inpatient outcomes were compared between non-Hispanic Black patients with a history of cocaine use and a primary admission diagnosis of ACS to determine whether race was a factor in treatment. A multivariate logistic regression was also performed to adjust for age, sex, ST-elevation myocardial infarction, tobacco use, and select comorbidities for cardiac catheterization and revascularization.

According to the study, 43,798 hospitalizations were identified for patients with a history of cocaine use and diagnosed with ACS. These were dichotomized into non-Hispanic Black patients and white patients, with 26,905 total hospitalizations (61.4%) for Black patients. This group had lower rates of cardiac catheterization (61.7% vs 72.5%) and revascularization (38.4% vs 52.1%) compared to white patients. Furthermore, the lower rates of cardiac catheterization and revascularization persisted after adjusting for potential confounding factors.

“We saw that non-Hispanic Black patients with a history of cocaine use had a much lower rate of cardiac catheterization and revascularization compared to white patients who had a history of using cocaine,” said senior author Jelani K. Grant, MD, in the press release. “The results highlight a disparity that must be further investigated in this specific population, since a history of drug use and race should not affect whether to proceed with an invasive procedure that could potentially be lifesaving in the long term.”

The study authors expect to work with the community and other cardiologists to create actionable steps to address health equity across all cardiovascular diseases and treatments regardless of race, socioeconomics, demographics, or substance abuse history, according to the press release.

“Our hope is this study raises awareness of implicit biases that potentially exist when treating patients for acute coronary syndrome,” said co-author Carlos Vergara, MD, in the press release. “Now that our findings suggest this bias exists, we can work together to help achieve health equity by evaluating other social determinants of health which may be related to race and a history of cocaine use.”

REFERENCE

Racial Disparities Seen in Treatment for Patients With Acute Coronary Syndrome and History of Cocaine Use. News release. Society for Cardiovascular Angiography & Interventions; May 18, 2022. Accessed. May 23, 2022. https://scai.org/racial-disparities-seen-treatment-patients-acute-coronary-syndrome-and-history-cocaine-use#:~:text=The%20findings%20reveal%20rates%20of,blood%20flow%20to%20the%20heart.