Symptom Expression in Coronary Heart Disease and Revascularization Recommendations for Black and White Patients

• Published in: American journal of public health (1971) 2007-09, Vol.97 (9), p.1701-1708
• Main Authors: Hravnak, Marilyn, Whittle, Jeff, Kelley, Mary E, Sereika, Susan, Good, Chester B, Ibrahim, Said A, Conigliaro, Joseph
• Format: Article
• Language: English
• Subjects: African Americans - statistics & numerical data; Aged; Angina pectoris; Angina Pectoris - ethnology; Angina Pectoris - etiology; Biological and medical sciences; Cardiac Catheterization; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Chest Pain - ethnology; Chest Pain - etiology; Coronary Artery Bypass - utilization; Coronary Disease - diagnosis; Coronary Disease - ethnology; Coronary Disease - physiopathology; Coronary heart disease; Coronary Stenosis - diagnosis; Coronary Stenosis - ethnology; Coronary vessels; Decision Making; Dyspnea - ethnology; Dyspnea - etiology; European Continental Ancestry Group - statistics & numerical data; Fatigue - ethnology; Fatigue - etiology; Female; Heart; Heart attacks; Heart surgery; Hospitals; Humans; Intervention; Interviews as Topic; Intubation; Male; Medical sciences; Medical treatment; Middle Aged; Miscellaneous; Myocardial Revascularization - utilization; Pain; Patients; Pennsylvania; Practice Patterns, Physicians' - statistics & numerical data; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Questionnaires; Racial differences; Referral and Consultation - utilization; Research and Practice; Studies
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2005.084103

We examined whether symptoms of coronary heart disease vary between Black and White patients with coronary heart disease, whether presenting symptoms affect physicians' revascularization recommendations, and whether the effect of symptoms upon recommendations differs in Black and White patients. We interviewed Black and White patients in Pittsburgh in 1997 to 1999 who were undergoing elective coronary catheterization. We interviewed them regarding their symptoms, and we interviewed their cardiologist decision-makers regarding revascularization recommendations. We obtained coronary catheterization results by chart review. Black and White patients (N=1196; 9.7% Black) expressed similar prevalence of chest pain, angina equivalent, fatigue, and other symptoms, but Black patients had more shortness of breath (87% vs 72%, P=.001). When we considered only those patients with significant stenosis (n=737, 7.1% Black) and controlled for race, age, gender, and number of stenotic vessels, those who expressed shortness of breath were less likely to be recommended for revascularization (odds ratio=0.535; 95% confidence interval=0.375, 0.762; P