Examination of Racial Differences in Management of Cardiovascular Disease (original) (raw)
Related papers
Race and patient refusal of invasive cardiac procedures
Journal of General Internal Medicine, 2004
OBJECTIVE: To determine whether patients' decisions are an important determinant of nonuse of invasive cardiac procedures and whether decisions vary by race. DESIGN: Observational prospective cohort. PARTICIPANTS: Patients ( N = 681) enrolled at the exercise treadmill or the cardiac catheterization laboratories at a large Veterans Affairs hospital. MEASURES: Doctors' recommendations and patients' decisions were determined by both direct observation of doctor and patient verbal behavior and by review of medical charts. Performance of coronary angiography, angioplasty, and bypass surgery were determined by chart review for a minimum of 3 months follow-up. RESULTS: Coronary angiography was recommended after treadmill testing for 83 of 375 patients and 72 patients underwent angiography. Among 306 patients undergoing angiography, recommendations for coronary angioplasty or bypass surgery were given to 113 and 45 patients and were completed for 98 and 33 patients, respectively. Recommendations were not significantly different by race. However, 4 of 83 (4.8%) patients declined or did not return for recommended angiograms and this was somewhat more likely among black and Hispanic patients, compared with white patients (13% and 33% vs 2%; P = .05). No patients declined angioplasty and 2 of 45 (4.4%) patients declined or did not return for recommended bypass surgery. Other recommended procedures were not completed after further medical evaluation ( n = 32). There was no difference ( P > .05) by race/ethnicity in doctor-level reasons for nonreceipt of recommended invasive cardiac procedures. CONCLUSIONS: Patient decisions to decline recommended invasive cardiac procedures were infrequent and may explain only a small fraction of racial disparities in the use of invasive cardiac procedures. KEY WORDS: patient acceptance of health care; treatment refusal; ethnic groups; racial variation; coronary artery disease. J GEN INTERN MED 2004;19:962-966.
Journal of the American College of Cardiology, 1997
Objectives. This study sought to investigate the independent effect of ethnicity on the utilization of invasive cardiac procedures after acute myocardial infarction (AMI). Background. The precise role of ethnicity in access to cardiovascular procedures is unknown, particularly because of difficulty in isolating ethnicity from financial and other socioeconomic factors. We conducted a retrospective analysis of the use of cardiac catheterization and coronary revascularization procedures after AMI in military health care beneficiaries. The Military Health Services System (MHSS) ensures equal access to care in an environment without financial incentives for procedural utilization; furthermore, socioeconomic differences between patients beyond ethnicity are minimized. Methods. Data were analyzed from the Civilian External Peer Review Program representing abstracted chart reviews from 125 military health care facilities worldwide for all patients (1,208 white; 233 nonwhite [155 black]) with the principal or secondary diagnosis of AMI from March to September 1993. Results. Rates of cardiac catheterization were similar in white and nonwhite patients (34.8 vs. 39.1%, p ؍ 0.21). After controlling for age, gender, cardiovascular risk factors and AMI variables, including infarct size and other risk markers, there were no differences in the use of this procedure during the AMI admission in comparisons of white versus nonwhite patients (estimated odds ratio [OR] 0.96, 95% confidence interval [CI] 0.69 to 1.34) and white versus black patients (OR 1.19, 95% CI 0.80 to 1.78). However, white patients were significantly more likely than nonwhite patients to be "considered" for future cardiac catheterization (OR 1.77, 95% CI 1.19 to 2.61). Coronary revascularization within 180 days was not significantly affected by race in white versus nonwhite (OR 0.90, 95% CI 0.59 to 1.39) and white versus black patients (OR 1.11, 95% CI 0.65 to 1.89). Outcomes (30-and 180-day mortality and readmission rates) were similar for all race groups. Conclusions. There is a limited relation between ethnicity and the use of invasive cardiac procedures in the MHSS. These data raise the promise that characteristics of a health care system can mitigate ethnic bias in medicine.
Racial Disparity in Cardiac Decision Making
Archives of Internal Medicine, 1998
Background: While numerous studies suggest that African Americans receive fewer invasive cardiac procedures than whites, the basis for these treatment differences is not understood. Methods: Weconductedfocusgroupsessionswithpatients who had received treatment in the hospital or the emergency departmentwithinthepreceding3monthsforischemicheart disease at 2 urban, university-affiliated hospitals.
The American Journal of Cardiology, 2009
To determine whether Hispanic and African-American patients are treated by cardiac surgeons with better or worse risk-standardized outcomes than surgeons of white patients, clinical data from the Massachusetts Data Analysis Center Registry were analyzed on all patients who underwent isolated coronary artery bypass grafting (CABG) from 2002 to 2004 by surgeons who performed >10 operations. Surgeons were divided into 4 groups based on their risk-standardized 30-day all-cause mortality incidence rates (top decile, top quartile, bottom quartile, and bottom decile). A total of 12,973 isolated CABGs were performed by 56 surgeons for 11,800 whites (91%), 413 Hispanics (3.2%), and 251 African-Americans (1.9%). White patients were more likely to be treated by surgeons in the top decile than by surgeons in the bottom decile (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.07 to 1.76). In contrast, Hispanic patients were almost 3 times more likely to be treated by surgeons in the bottom decile compared with the top decile (OR 2.85, 95% CI 1.82 to 4.47). Compared with whites, Hispanic patients were about 1/2 as less likely to be treated by surgeons in the top decile (OR 0.51, 95% CI 0.35 to 0.75). African-American and white patients were similarly likely to be treated by surgeons in the top-and bottom-quality performance groups. In conclusion, Hispanics undergoing isolated CABG in Massachusetts were more likely to be operated on by cardiac surgeons with higher risk-standardized mortality rates than by surgeons with lower rates.
Racial/Ethnic Variations in Physician Recommendations for Cardiac Revascularization
American Journal of Public Health, 2003
Objectives. We sought to examine whether physician recommendations for cardiac revascularization vary according to patient race. Methods. We studied patients scheduled for coronary angiography at 2 hospitals, one public and one private, between November 1997 and June 1999. Cardiologists were interviewed regarding their recommendations for cardiac resvacularization. Results. African American patients were less likely than Whites to be recommended for revascularization at the public hospital (adjusted odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.12, 0.77) but not at the private hospital (adjusted OR = 1.69; 95% CI = 0.69, 4.14). Conclusions. Physician recommendations for cardiac revascularization vary by patient race. Further studies are needed to examine physician bias as a factor in racial disparities in cardiac care and outcomes.
Blacks in the coronary artery surgery study (CASS): race and clinical decision making
American Journal of Public Health, 1986
For patients enrolled in the Coronary Artery Surgery Study (CASS), surgery was recommended for 46.5 per cent of Blacks and 59.4 per cent of Whites, despite similar clinical and angiographic characteristics. Of those recommended, 80.5 per cent of Blacks and 90.4 per cent of Whites had bypass surgery. These differences were most apparent for Black laborers. Overall, only 38.0 per cent of Blacks had coronary artery bypass surgery, whereas 58.4 per cent of Whites received surgery.