Previous studies have demonstrated that minority patients treated for a number of heart conditions receive substandard care compared to Caucasians. A new study from UHealth cardiologists led by Mauricio G. Cohen, M.D., associate professor of medicine in the Cardiovascular Division, is the first to show that hospitals participating in a quality improvement program such as the American Heart Association’s Get With The Guidelines®–Coronary Artery Disease (CAD) can eliminate disparities in cardiovascular quality of care. Such programs can also increase the overall use of evidence-based care for heart attack patients.

Mauricio G. Cohen, M.D.

The American Heart Association’s Get With The Guidelines quality improvement program was designed to help hospitals implement evidence-based treatments. Cohen, who is also director of the Cardiac Catheterization Laboratory at University of Miami Hospital, collaborated with seven other cardiologists, including Mauro Moscucci, M.D., M.B.A., professor and clinical vice chair of medicine and chief of the Cardiovascular Division.

For this study, researchers looked at the records of more than 142,000 patients (Caucasian, African-American, and Hispanic) who were treated for heart attacks at 443 hospitals participating in Get With The Guidelines–CAD from January 2002 to June 2007. They examined trends over time in hospitals’ use of performance measures to evaluate treatments and inter-
ventions that improve patient outcomes, including interventions such as administering aspirin, beta-blockers, and other appropriate medications; cholesterol-lowering therapies; and smoking cessation counseling. These are considered the ‘must-dos’ in the care of heart attack patients and are supported by strong clinical trial data and ample consensus.

Throughout the five years, the use of individual performance measures in the overall population was high and steadily improved for all three patient groups. “Our most notable finding was that the initial racial-ethnic differences in care slowly decreased as sites continued to participate in the Get With The Guidelines quality improvement initiative,” Cohen said. “By the second half of the study, the differences were no longer significant; by the end of the study, they were completely eliminated.

“Additionally, care improved across all hospitals over the study period—even at those that disproportionately cared for African-Americans and Hispanics. Prior research has suggested that one of the reasons for disparate care is that minority patients are more likely to be treated at hospitals that provide inferior care. But our findings demonstrated that this is not the case among hospitals participating in this quality improvement program.”