Disparities in Cardiovascular Care

Last year, an Institute of Medicine panel identified health care delivery and disparities as the nation’s top 2 priorities for comparative effectiveness research.1 We have long known that disparities in the delivery of cardiovascular care are pervasive and harmful; the literature is robust and clear. These disturbing disparities are most prominent for emerging high-technology procedures. Compared with whites, blacks are less likely to undergo coronary angiography and revascularization and are more likely to die of cardiovascular disease.2 As the cardiovascular research community moves from describing disparities to finding solutions, a key question emerges: Will improving quality of care for all patients eliminate disparities, or should we tailor our approach and target particular contributors and populations?Article see p 2294 In this issue of Circulation , Cohen et al3 used data from the American Heart Association’s (AHA) Get With the Guidelines (GWTG) program to address the long-standing debate of whether improving quality of care overall is enough to eliminate disparities in care. Based on a sample of >140 000 patients with acute myocardial infarction seen in 443 hospitals between 2002 and 2007, the authors found that a general trend toward improved quality of care was associated with an apparent elimination of disparities. In 2002, 70% of whites and Hispanics received “defect-free care,” whereas only 60% of blacks did; by 2007, well over 90% of all patients received defect-free care with no substantial differences in ethnic groups.The AHA GWTG program is a remarkable quality improvement collaborative. Participation in the GWTG–Coronary Artery Disease (CAD) program has been independently associated with improvements in guideline adherence above that in other hospitals participating in public reporting programs.4 Many hospitals enrolled in the GWTG program achieve extraordinarily high levels of recommended care for …