Note to editors: A news conference outlining results of this study will be presented at 9:45 a.m. CST, Sunday, Nov. 8, in room A215-A217 at the Dallas Convention Center.
DALLAS -- 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 cholesterol."
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 non-Hispanic.
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 percent).
- Fewer Hispanics lived alone (10 percent) compared to non-Hispanics (19 percent).
- 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).
- Despite these differences, the 30-day death rate was similar in both
groups : 6.4 percent for Hispanics and 6.6 percent for non-Hispanics.