Perceived discrimination associated with higher risk of poorer outcomes in the year after a heart attack

Perceived discrimination associated with higher risk of poorer outcomes in the year after a heart attack

A study of more than 2,600 young heart attack survivors under the age of 55 found that those who reported experiencing more discrimination in their daily lives had a higher risk of worse outcomes in the year after a heart attack, according to preliminary research to be presented at the American Heart Association's 2022 Scientific Sessions. The meeting, held live in Chicago and virtually November 5-7, 2022, is a premier global exchange on the latest scientific advances, research and evidence-based clinical practice updates in cardiovascular science.

Perceived discrimination refers to the perception of being treated unfairly in everyday interactions based on personal characteristics such as race, gender, ethnicity, or socioeconomic status. Previous research suggests that perceived discrimination is associated with several risk factors for heart attack, but little is known about the association between discrimination and health status outcomes after a heart attack.

Perceived discrimination acts as a chronic stressor that negatively influences cardiovascular disease through increased stress levels and inflammation. Perceived discrimination is also associated with other psychosocial factors, such as low social support and mistrust of the healthcare system, which can affect patients' recovery from a heart attack."

Andrew Arakaki, MPH and doctoral candidate in the Department of Chronic Disease Epidemiology at the Yale School of Public Health in New Haven, Connecticut

Researchers examined health data from participants in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) trial to analyze health outcomes after a heart attack, including chest pain, physical limitations, patient-reported general physical and mental health status, treatment satisfaction and quality of life. Participants were between 18 and 55 years old and had been hospitalized for a heart attack in the United States between 2008 and 2012. Two-thirds of the 2670 participants (67%) were women; 76% self-identified as white adults, 17% as black adults, and 6% identified their race as “other,” including American Indian/Alaska Native, Asian, Pacific Islander, and East Indian. The researchers noted that Hispanic versus non-Hispanic was defined as an ethnicity separate from race, with 7.7% of participants identifying as Hispanic.

Participants completed three questionnaires at 1 month and 12 months after the heart attack to assess the level of perceived discrimination, heart attack recovery status (physical limitation and frequency of chest pain), quality of life, and general health status. They reported perceived discrimination of any kind (such as racism and sexism), general physical and mental health status, heart attack recovery status, treatment satisfaction, and quality of life using standardized research instruments (Everyday Discrimination Scale; Short Form 12 Scale; and Seattle Angina Questionnaire).

The analyzes of the questionnaire results and data revealed:

• Mehr als ein Drittel der Teilnehmenden gab an, in ihrem Alltag Diskriminierung erlebt zu haben.
• Eine höhere Exposition gegenüber wahrgenommener Diskriminierung war in erster Linie mit einem schlechteren Genesungsstatus des Herzinfarkts verbunden (angezeigt durch niedrigere Werte im Seattle Angina Questionnaire).
• Menschen mit einem höheren Maß an wahrgenommener Diskriminierung berichteten bis zu einem Jahr nach der Genesungsphase nach einem Herzinfarkt mit größerer Wahrscheinlichkeit über körperliche Einschränkungen und häufigere Schmerzen in der Brust.
• Patienten, die über ein höheres Maß an wahrgenommener Diskriminierung berichteten, berichteten auch über einen schlechteren psychischen Gesundheitszustand, eine schlechtere Behandlungszufriedenheit und Lebensqualität innerhalb des ersten Jahres nach ihrem Herzinfarkt.

“We were surprised to discover how common perceived discrimination was among participants in our study sample, and healthcare professionals should be aware that this appears to play an important role in patient recovery,” Arakaki said. "It is also important to highlight that perceived discrimination had a greater impact on heart attack-specific outcomes compared to general/general measures of physical and mental health status. This suggests that perceived discrimination may be particularly important when treating young patients (age 18-55) recovering from a heart attack."

"Future research is needed to understand how to support patients with high levels of perceived discrimination during heart attack recovery and whether perceived discrimination is a stronger determinant of outcomes among people from different racial, ethnic or social groups or among people living in under-resourced communities, or whether other social determinants of health may also play a role," he added.

Because the majority of participants were white and women and the analyzes in this study did not include participants who did not complete the perceived discrimination questionnaire, the results may not be generalizable to the public. Future studies examining perceived discrimination should include more people from different racial and ethnic groups. The study also did not assess the associations between specific types of discrimination (e.g., racism, sexism) and health outcomes.

“The findings regarding the association between perceived discrimination and health outcomes, quality of health outcomes, quality of life outcomes, and mental and physical health sharing increased risk were not surprising because we know that psychosocial stressors have an impact on cardiovascular health and disease,” said Michelle A. Albert, MD, MPH, FAHA, president of the American Heart Association, the Walter A. Haas-Lucie Stern Endowed Chair in Cardiology and professor of Medicine at the University of California, San Francisco.

“What is needed in the literature are studies that assess the relationship between everyday discrimination and specific cardiovascular health outcomes as well as health outcomes in general, particularly data at multiple time points,” she said. "Health care professionals need to truly understand the impact of structural racism and structural discrimination on health outcomes in this sense. That means we need to double down on having culturally competent physicians and other health care professionals who understand the lived experiences of their patients. as well as who listen to their patients' concerns."

Source:

American Heart Association

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