Gender differences across racial and ethnic groups in the quality of care for acute myocardial infarction and heart failure associated with comorbidities

This paper provides important insights on gender differences across racial and ethnic groups in a Medicare population in terms of the quality of care received for acute myocardial infarction (AMI) and congestive heart failure (CHF) in association with diabetes or hypertension/end-stage renal disease (ESRD). Both race/ethnicity and gender are associated with differences in the diagnostic evaluation and treatment of Medicare recipients with these conditions. In the AMI group, non-Hispanic Black and Hispanic patients of both genders were less likely to receive aspirin or β-blockers than non-Hispanic Whites. These differences persisted for Hispanic women and men even when they presented with ESRD or diabetes. Rates for smoking cessation counseling were among the lowest among non-Hispanic Blacks and Hispanics with AMI–diabetes and non-Hispanic blacks with AMI–hypertension/ESRD. Gender comparisons within racial groups for the AMI and AMI–diabetes groups show that among non-Hispanic Whites, women were less likely to receive aspirin and β-blockers. No gender differences were noted among non-Hispanic Black and Hispanic Medicare recipients. In the CHF group, Hispanics were the racial/ethnic group least likely to have an assessment of left ventricular function (LVF), even if they had diabetes and had lower rates of angiotensin-converting enzyme inhibitor therapy or even if they had combined CHF–hypertension/ESRD. Gender comparisons in both the CHF and CHF–hypertension/ESRD groups show that non-Hispanic White women were less likely to have an LVF assessment than non-Hispanic White men. Among all subjects, having comorbidities with AMI was not associated with higher markers of quality cardiovascular care. Closing the many gaps in cardiovascular care must target the specific needs of women and men across racial and ethnic groups.

Keywords:  acute myocardial infarction , heart disease , coronary heart disease , heart failure , congestive heart failure , health care quality , disparities in health care , gender-based research , women’s health , men’s health , older adults , aged , elderly