NEW YORK, Feb 12 (Reuters) -- African Americans are much less likely to undergo artery-clearing heart bypass surgery than Caucasians according to new findings based on a review of more than 12,000 coronary disease patients.
Reasons for the disparity are unclear, but researchers say patient preferences may be key factors.
"Our findings are consistent with other institutional reviews that found blacks were less likely than whites to opt for surgery," says Dr. Eric Peterson, the Duke University cardiologist who led the investigation.
Peterson notes that many African American patients he and his colleagues see in heart clinics prefer a less invasive, less high-tech approach to disease treatment.
"I know that among my own patients, there is a considerable difference in preferences. That may be due to a combination of religious values, cultural mores, and/or one's trust in aggressive medical approaches, which often present high risks," he says.
The Duke report, which appears in this week's issue of The New England Journal of Medicine, based its findings on a review of the University's data bank which contains information on more than 100,000 cardiac patients seen at the medical center over the last 28 years. This is the nation's largest single computerized repository of such information.
For this study, the researchers focused on 12,402 patients, of whom about 10% were African American, treated at the Durham, North Carolina, medical institution between 1984 and 1992.
The African American patients were slightly younger than Caucasian patients, and more black patients were women. In addition, African American patients were more likely to have diabetes and high blood pressure.
"After adjustment for the severity of disease and other characteristics, blacks were 13% less likely than whites to undergo angioplasty and 32% less likely to undergo bypass surgery," the researchers state.
Peterson further points out that "the greatest racial disparity in the use of bypass surgery was actually among the patients who stood the most to gain from it" -- those with severely blocked coronary arteries.
The cardiologist and his colleagues found that 48% of African Americans with severe coronary disease underwent surgery versus 65% of Caucasians. But the corresponding figures were 12% and 15%, respectively, for patients without severe blockages in their coronary arteries.
And the Duke team also found racial disparities in long-term survival. A comparison of survival rates during a five-year follow-up study found survival "significantly lower in blacks than in whites," the researchers state. Specifically, African Americans were 18% more likely to die than Caucasians.
But not so clear cut is why the disparity in care exists. As the researchers point out, the Duke records may be some of the most detailed available, but they do not include information on what treatments doctors recommended to patients or whether patients chose to follow the recommendations.
Moreover, the records do not reflect whether a decision not to go ahead with bypass surgery was made upon examination of angiograms -- diagnostic tests that show the extent of coronary disease. Not all patients with coronary blockages are prime candidates for surgery, Peterson explains.
Still, he and his colleagues conclude that artery-clearing treatments, including angioplasty and bypass surgery, "may have been underused in treating blacks."
"This disparity in treatment exists nationwide, and we see the study as a call to action to improve physician-patient interactions, which are crucial at arriving at the best course of treatment," Peterson says.
SOURCE: The New England Journal of Medicine (1997;336:480-486)
