Disparate Care for Acute Myocardial Infarction

"... a rising tide lifts all boats." Sen. John F. Kennedy, September 27, 1960 The seminal Institute of Medicine report, "Unequal Treatment", established the definite penetration of disparate care throughout all of medicine. At first glance, any major differences in health outcomes between groups of patients might be declared as evidence of a health care disparity- applying that definition generically. But, this IOM report established a striking contrast between differences that are appropriate and are largely based on patient preference, disease severity and treatment indication vs. differences due to overtly non-physiological influences that result in less than ideal outcomes. The differences attributable to this latter concern thus constitute true health care disparities and represent an appropriate target for interventions to either profoundly narrow or preferably eliminate those disparate outcomes that are non-physiologic in origin. Specifically, the root causes of disparate care include system level issues that largely reflect cultural competency or lack thereof, e.g., language, geographic and economic barriers to care; provider level concerns that focus on the perverse influence of bias and stereotyping; and community level issues, especially the built environment and the social determinants of health. Given the steady focus on addressing and eliminating health care disparities, it is expected that many of us have grown weary over these messages. However, the data presented by Mathews et al require us to remain resolute in our focus. Disparate care persists in cardiovascular medicine and tempers our exuberance that we are making transformational progress in the treatment of heart disease.