Do patient preferences contribute to racial differences in cardiovascular procedure use?
OBJECTIVE
To determine whether patient preferences for the use of coronary revascularization procedures differ between white and black Americans.


METHODS
Cross-sectional survey.


METHODS
Tertiary care Department of Veterans Affairs hospital.


METHODS
Outpatients with and without known coronary artery disease were interviewed while awaiting appointments (n = 272). Inpatients awaiting catheterization were approached the day before the scheduled procedure (n = 80). Overall, 118 blacks and 234 whites were included in the study.


RESULTS
Patient responses to questions regarding (1) willingness to undergo angioplasty or coronary artery bypass surgery if recommended by their physician and (2) whether they would elect bypass surgery if they were in either of two hypothetical scenarios, one in which bypass surgery would improve symptoms but not survival and one in which it would improve both symptoms and survival. Blacks were less likely to say they would undergo revascularization procedures than whites. However, questions dealing with familiarity with the procedure were much stronger predictors of a positive attitude toward the procedure use. Patients who were not working or over 65 years of age were also less interested in procedure use. In multivariable analysis race was not a significant predictor of attitudes toward revascularization except for angioplasty recommended by their physician.


CONCLUSIONS
Racial differences in revascularization rates may be due in part to differences in patient preferences. However, preferences were more closely related to questions assessing various aspects of familiarity with the procedure. Patients of all races may benefit from improved communication regarding proposed revascularization. Further research should address this issue in patients contemplating actual revascularization.
Whittle
J
J
Section of General Internal Medicine, Pittsburgh Veterans Affairs Medical Center, PA 15240, USA.
Conigliaro
J
J
Good
C B
CB
Joswiak
M
M
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D044383:Black People; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000208:ethnology* / Q000628:therapy; D003430:Cross-Sectional Studies; D003625:Data Collection; D003657:Decision Making; D007722:Health Knowledge, Attitudes, Practice; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction / Q000208:ethnology*; D010414:Pennsylvania; D010817:Physician-Patient Relations; D044465:White People; D001741:Black or African American