Tarryn Tertulien, M.D., M.Sc.
If you’re Black and diagnosed with a heart attack referred to as “N-STEMI,” you’re less likely to receive two essential procedures, the New Pittsburgh Courier has learned.
New research published in July in the Journal of the American Heart Association revealed that “significant differences” in initial heart attack diagnosis and treatment were found among Black and Hispanic adults compared to White adults. Researchers examined the health claims of more than 87,000 people diagnosed with non-ST Elevation Myocardial Infarction (N-STEMI), a type of heart attack in which an artery is partially blocked and severely reduces blood flow. The investigators analyzed racial and ethnic differences in the use of two common, essential procedures: coronary angiography and percutaneous intervention (PCI). According to a release from the American Heart Association, coronary angiography is a diagnostic procedure that uses a dye and x-rays to visualize blood flowing through the coronary arteries to determine if a blockage in one or more arteries is causing the heart attack. PCI is a minimally invasive method of threading a slim hollow tube from a blood vessel in the arm or thigh until it reaches the blockage and opening the artery by inflating a balloon at the tube’s tip. The artery may be held open with a small, permanent tube called a stent.
The data came from claims made in the years 2017-2019.
The data revealed that Black adults were 7 percent less likely to undergo coronary angiography and 14 percent less likely to have PCI compared to White adults in the study.
“It’s pretty alarming,” Tarryn Tertulien, M.D., M.Sc., lead author of the study and a resident in internal medicine at the University of Pittsburgh Medical Center, told the Courier in an exclusive interview, Aug. 2.
The report studied those who had some type of insurance (private or Medicare Advantage). Those who were uninsured altogether were not part of the study. The study found that those who had lower annual incomes within each racial and ethnic group were less likely to receive coronary angiography.
With that information, “We expect that the association we found between race and ethnicity and N-STEMI treatment would be even more profound in people without insurance,” Dr. Tertulien said.
Dr. Tertulien said that historically, studies have shown that African Americans receive, as a whole, lesser treatment than Whites in a number of medical factions, as she performs a lot of studies in health equity. But even she thought that in today’s world, “contemporary data” would show that treatment has become nearly equal for all ethnicities.
At least in this study, that wasn’t the case.
“I would say this data was a little surprising in the sense that there’s a lot more awareness of these disparities, and my thinking was, I would see less disparities,” Dr. Tertulien told the Courier. “But the fact that we were able to see these disparities persistent in contemporary data…it’s something we really need to address in the future.”
Dr. Tertulien said the study did not examine the eventual health outcomes of the African Americans or Hispanics who didn’t receive the procedures. However, “based on what we see clinically,” she said, “if one does not obtain the treatment in a timely manner, it can have consequences such as abnormal heart rates or even heart failure in the long term.”
African Americans are 30 percent more likely to die from heart disease than non-Hispanic Whites, according to information from the Centers for Disease Control and Prevention. And although African American adults are 40 percent more likely to have high blood pressure, they are less likely than non-Hispanic Whites to have their blood pressure under control. For African American women, the CDC says they are nearly 60 percent more likely to have high blood pressure compared to non-Hispanic White women.
“Physicians have three essential responsibilities,” said senior study author Jared W. Magnani, M.D., M.Sc., an associate professor of medicine at the University of Pittsburgh, in a release provided to the Courier. “First, they must practice medicine that is blind to race and ethnicity, providing the same standard of care regardless of gender, race, ethnicity or other social factors. Second, they must understand how patients’ life experiences—due to structural factors, racism, financial obstacles and other social determinants—may influence risk factors, access to care and how serious their condition is at presentation. Third, they must be aware of their personal biases, which may influence their ability to provide equitable care.”
Dr. Tertulien said the responsibility isn’t solely on Black and Hispanic patients to demand to their physician that they have coronary angiography and PCI. But, “patients should be aware of the kind of treatments that are expected” for things like N-STEMI, she told the Courier. “It’s a structural issue from a health care system, provider standpoint, to recognize that we all have these biases…these biases are very real and we just need to start addressing them.”