John A. Spertus, MD, MPH; Philip G. Jones, MS; Harlan M. Krumholz, MD, SM
Potential Conflict of Interest: None disclosed.
Spertus JA, Jones PG, Krumholz HM. Racial Differences in Myocardial Infarction Outcomes. Ann Intern Med. 2009;151:823. doi: 10.7326/0003-4819-151-11-200912010-00019
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Published: Ann Intern Med. 2009;151(11):823.
Dr. Webster is correct that we found disparities in quality of care by race. The differences were, for the most part, modest in absolute terms, and each measure is relevant to only a subset of the patients. Therefore, we are not surprised that differences in the quality measures did not have a dominant effect in explaining differences in outcomes among the entire cohort. This does not suggest that the indicators are unimportant to the subset of patients to whom they apply or that addressing the disparity is unimportant. But when the entire group and the differences in outcomes are considered, differences in patients' clinical characteristics on admission explain much of the difference in outcomes. Nevertheless, we emphatically support the use of evidence-based therapies in all patients, regardless of race.
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