Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs

JAMA. 1994 Apr 20;271(15):1175-80.


Objective: To examine whether blacks admitted to Veterans Affairs Medical Centers (VAMCs) with an acute myocardial infarction (AMI) are less likely than whites to undergo cardiac catheterization or coronary revascularization procedures and to determine the impact of these differences on patient survival.

Design: A retrospective observational study of inpatient discharge abstracts from the Veterans Health Administration (VHA).

Setting: All one hundred fifty-eight acute care hospitals in the VHA.

Patient population: Male veterans (n = 33,641) discharge from VAMCs with an International Classification of Diseases, Ninth Revision, Clinical Modification code for AMI from January 1, 1988, to December 31, 1990.

Intervention: None.

Main outcome measures: The use of cardiac catheterization, coronary angioplasty, and/or bypass surgery in the 90 days after admission for AMI, and survival at 30 days, 1 year, and 2 years.

Main results: Adjusting for patient and hospital characteristics, blacks with an AMI were 33% less likely than whites to undergo cardiac catheterization, 42% less likely to receive coronary angioplasty, and 54% less likely to receive coronary bypass surgery. Among patients who underwent catheterization, blacks were also less likely than whites to have a subsequent cardiac revascularization procedure. Adjusted 30-day survival for blacks was significantly greater than for whites. One- and 2-year survival rates after AMI were not significantly different between blacks and whites.

Conclusions: In a health care system designed to provide equivalent availability of care to all eligible patients, blacks received substantially fewer cardiac procedures after AMI than whites. Despite undergoing fewer interventional procedures, blacks had better short-term and equivalent intermediate survival rates compared with whites.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Black or African American / statistics & numerical data*
  • Cardiac Catheterization / statistics & numerical data*
  • Hospitals, Veterans / standards*
  • Hospitals, Veterans / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality*
  • Myocardial Infarction / therapy*
  • Myocardial Revascularization / statistics & numerical data*
  • Patient Selection*
  • Regression Analysis
  • Retrospective Studies
  • Survival Rate
  • United States
  • White People / statistics & numerical data