Inequalities in care in patients with acute myocardial infarction

Abstract

Coronary heart disease is the single largest cause of death in developed countries. Guidelines exist for the management of acute myocardial infarction (AMI), yet despite these, significant inequalities exist in the care of these patients. The elderly, deprived socioeconomic groups, females and non-caucasians are the patient populations where practice tends to deviate more frequently from the evidence base. Elderly patients often had higher mortality rates after having an AMI compared to younger patients. They also tended to present with symptoms that were not entirely consistent with an AMI, thus partially contributing to the inequalities in care that is seen between younger and older patients. Furthermore the lack of guidelines in the elderly age group presenting with AMI can often make decision making challenging and may account for the discrepancies in care that are prevalent between younger and older patients. Other patients such as those from a lower socioeconomic group, i.e., low income and less than high school education often had poorer health and reduced life expectancy compared to patients from a higher socioeconomic group after an AMI. Lower socioeconomic status was also seen to be contributing to racial and geographical variation is the care in AMI patients. Females with an AMI were treated less aggressively and had poorer outcomes when compared to males. However even when females were treated in the same way they continued to have higher in hospital mortality which suggests that gender may well account for differences in outcomes. The purpose of this review is to identify the inequalities in care for patients who present with an AMI and explore potential reasons for why these occur. Greater attention to the management and a better understanding of the root causes of these inequalities in care may help to reduce morbidity and mortality rates associated with AMI.

Keywords: Coronary artery disease; Dual antiplatelet therapy; Inequalities; Guidelines; Myocardial infarction

Core tip: Coronary heart disease is the leading cause of death in developed countries. Guidelines exist for the management of acute myocardial infarction (AMI), yet despite these, significant inequalities exist in patient care. The elderly, deprived socioeconomic groups, females and non-Caucasians are the patient populations where practice tends to deviate from the evidence base. The purpose of this review article is to identify the inequalities in those who present with an AMI and explore potential reasons for this. Greater attention to the management and a better understanding of the root causes of these inequalities may help to reduce morbidity and mortality rates.