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A study was conducted to investigate the association between a lack of health insurance and financial constraints on accessing care among those with health insurance and the time taken from onset to hospital admission in acute myocardial infarction (AMI). Results indicated that such factors did contribute to delays in seeking emergency care for AMI.

The study attempts to estimate racial differences in survival for patients following in-hospital cardiac arrests and the factors associated with it. The results indicate that African-American patients were less likely to survive discharge as compared to white patients and also that most of the racial differences were associated with the hospital in which African-American patients received care.

A study was conducted to evaluate whether patients receiving an implantable cardioverter-defibrillator (ICD) from nonelectrophysiologists had more negative outcomes as compared to implants done by electrophysiologists who were certified for the procedure. Results indicated that implants done by nonelectrophysiologists had a higher risk of procedural complications.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.03.069 Byline: Saif S. Rathore (a), Kevin P. Weinfurt (c), JoAnne M. Foody (a), Harlan M. Krumholz (a)(b)(d)(e)(f) Abstract: The TIMI ST-elevation myocardial infarction (STEMI) score was developed and validated in a randomized controlled trial population. We sought to assess its accuracy in a community-based cohort of elderly patients hospitalized with STEMI. Author Affiliation: (a) Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn (b) Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (c) Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (d) Qualidigm, Middletown, Conn (e) Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn (f) The Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Conn Article History: Received 18 November 2003; Accepted 29 March 2005 Article Note: (footnote) Saif Rathore was supported by NIH/National Institute of General Medical Sciences Medical Scientist Training Grant GM07205.

Sex and racial differences in the treatment of patients who were deemed to be 'ideal candidates' for particular treatment and in deaths among 598,911 patients hospitalized with myocardial infarction is examined between 1994 and 2002. Rates of reperfusion therapy, coronary angiography, and in-hospital death after myocardial infarction, but not the use of aspirin and beta-blockers, vary according to race and sex.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2004.08.018 Byline: Saif S. Rathore (a)(b), Paul D. Frederick (e), Nathan R. Every (e), Hal V. Barron (f), Harlan M. Krumholz (a)(c)(d) Abstract: Racial differences in reperfusion therapy use among patients hospitalized with myocardial infarction (MI) have been previously reported as national phenomenon. However, it is unclear whether racial differences in treatment vary by region. Author Affiliation: (a) Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn (b) MD/PhD Program, Yale University School of Medicine, New Haven, Conn (c) Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (d) Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn (e) Ovation Research Group, Chicago, Ill (f) Genentech, Incorporated, South San Francisco, Calif Article History: Received 13 January 2004; Accepted 17 August 2004 Article Note: (miscellaneous) The National Registry of Myocardial Infarction-2 and -3 is supported by Genentech, Inc, South San Francisco, Calif. Mr Rathore is supported by National Institutes of Health National Institute of General Medical Sciences Medical Scientist Training Grant GM07205.

Concerns about the rationale for regionalized acute coronary syndromes (ACS) care are presented and some potential unintended consequences are outlined. Proponents contend that regionalized ACXS would save lives by improving access to new technologies, specialist physicians, and higher-quality care not available at other centers.

Elderly African-Americans who have heart failure receive the same quality of care that white patients do, according to a study of 29,732 Medicare patients. The African-American patients were hospitalized more frequently but had lower death rates than the white patients. African-Americans are more likely to develop heart failure than whites.

Patients with congestive heart failure who are taking digoxin should have the dose adjusted to produce a blood level between 0.5 and 0.8 nanograms per milliliter. Blood levels higher than that may increase their risk of death, according to a study of 3,782 patients. All of the men in the study had a left ventricular ejection fraction of 45% or less.

The heart drug digoxin may actually increase the risk of death in women with heart failure, according to a study of 6,800 men and women with heart failure. This effect was not seen in men. Doctors should be cautious about prescribing digoxin for women with heart failure.

Women who have had a heart attack are less likely than men to have cardiac catheterization even when the woman's doctor is also a woman. This means that bias on the part of male doctors is not responsible for the lower rate of cardiac catheterization in female cardiac patients., Context Many studies indicate that women are less likely than men to undergo cardiac procedures after an acute myocardial infarction (AMI), raising concerns of sexual bias in clinical care. However, no data exist regarding the relationship between patient sex, physician sex, and use of cardiac procedures. Objective To determine whether sex differences in cardiac catheterization after AMI were greater when patients were treated by male attending physicians compared with female attending physicians. Design, Setting, and Patients Analysis of data from the Cooperative Cardiovascular Project, a retrospective medical record review. A total of 104231 Medicare fee-for-service beneficiaries who were hospitalized in US acute care hospitals for an AMI between January 1994 and February 1995. Main Outcome Measure Use of cardiac catheterization within 60 days of admission, compared between the 4 groups of patient sex-physician sex combinations. Results Women underwent fewer cardiac catheterizations than men when treated by either male physicians (38.6% vs 50.8%; P=.001) or female physicians (34.8% vs 45.8%; P=.001). Sex differences in procedure use were not greater when a patient and physician were of different sexes (P for interaction=.85). After potential confounders in multivariable analysis were accounted for, women were less likely to undergo cardiac catheterization (risk ratio, 0.90 [95% confidence interval {CI}, 0.880.92]), regardless of the treating physician's sex. Patients treated by male physicians were more likely to undergo cardiac catheterization (risk ratio, 1.06 [95% CI, 1.02-1.10]) than those treated by female physicians, regardless of patient sex. Conclusions Women who have had an AMI undergo a cardiac catheterization less often than men, whether treated by a male or female physician. These results suggest that factors other than sexual bias by male physicians toward women account for sex differences in cardiac procedure use.

A blood transfusion can lower the mortality rate in elderly heart attack patients who have anemia, according to a study of 78,974 patients. A blood transfusion should be given to all elderly heart attack patients who have a hematocrit of 30% or less.

Black heart attack patients who are treated by a black doctor are no more likely to have cardiac catheterization then black patients treated by a white doctor. Black heart attack patients as a group are less likely to have cardiac catheterization than whites, but a study of 35,676 white patients and 4,039 black patients found this was not caused by the race of the doctor.