Heart attacks, medically known as acute myocardial infarctions, remain one of the leading causes of death in the United States. While overall deaths have fallen over the past twenty years thanks to better treatment strategies, not every patient receives the same standard of care.
A new study headed by Charleen Hsuan, associate professor of health policy and administration at Penn State, found that Hispanic and non‑Hispanic Black adults in Florida who suffered a ST‑elevation myocardial infarction (STEMI) were less likely to receive the recommended percutaneous coronary intervention (PCI) than non‑Hispanic White patients.
The research was published in JAMA Network Open.
Hsuan comments: “I’ve always been interested in how emergency‑care quality can differ by insurance status and demographics. By focusing on one specific condition, we can start to pinpoint where disparities exist and where policy action is most needed.”
STEMIs comprise roughly one‑quarter of all heart attacks. Effective therapies for these high‑risk patients include thrombolytic drugs that dissolve clots and PCI, a minimally invasive procedure that widens blocked arteries. Clinical guidelines recommend PCI within 90 minutes if the first hospital can perform it, or within 120 minutes if a transfer is required.
Hsuan’s team examined 139,629 Florida residents diagnosed with STEMI from 2011 to 2021. They mapped each patient’s first hospital entry—whether it had PCI capability—and whether PCI was performed. If PCI was not offered at the initial site, the team tracked whether the patient was transferred to another facility and if PCI was subsequently administered.
The results revealed significant racial disparities at every step of the emergency‑care pathway:
• 82.6% of non‑Hispanic White patients initially presented to a PCI‑capable hospital, whereas fewer Black patients did the same.
• Among those who arrived at a capable hospital, Black patients were 10.7% less likely to receive PCI compared to White patients.
• Of patients who first came to a non‑PCI capable hospital, Black patients were 5.3% less likely to be transferred.
• When transferred, Black patients were 20.3% less likely to receive PCI at the receiving hospital.
Hispanic patients also faced gaps: they were 3.8% less likely to first arrive at a PCI‑capable hospital and 5.6% less likely to be transferred when starting at a non‑capable site.
“These are extremely large differences,” Hsuan noted. “They add up to explain the higher mortality observed in STEMI patients who are Hispanic or Black compared with White patients.”
The study highlights specific actions policymakers and hospital leaders could take—such as ensuring PCI is delivered at the first arrival site and that transferred patients receive PCI at their new hospital.
Although the data come from Florida alone, the findings are relevant nationwide. Florida is the third most populous state in the country, meaning millions of Americans could be affected. Further research is needed to identify the root causes of these gaps, which may include insurance coverage, hospital access, or geographic distribution.
Hsuan is continuing her investigation of transfer care processes nationwide. “While this work focuses on racial and ethnic disparities, it ultimately signals how emergency care can be improved for everyone. The main takeaway is that people are not getting the care recommended by experts, and by understanding why, we can close those gaps.”
Other contributors to the study include David J. Vanness, Haoyu Bi, and Jeannette Rogowski—all professors or students in Penn State’s health‑policy department.