title: Race and patient refusal of invasive cardiac procedures.
abstract: OBJECTIVE
  To determine whether patients' decisions are an important determinant of nonuse of invasive cardiac procedures and whether decisions vary by race.
  
  
  METHODS
  Observational prospective cohort.
  
  
  METHODS
  Patients (N= 681) enrolled at the exercise treadmill or the cardiac catheterization laboratories at a large Veterans Affairs hospital.
  
  
  METHODS
  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.
authors.affiliation: Houston Center for Quality of Care and Utilization Studies, Veterans Affairs Medical Center, Houston, TX 77030, USA. hgordon@bcm.tmc.edu
authors.forename: Howard S
authors.initials: HS
authors.lastname: Gordon
authors.forename: Debora A
authors.initials: DA
authors.lastname: Paterniti
authors.forename: Nelda P
authors.initials: NP
authors.lastname: Wray
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000175:diagnosis* / Q000208:ethnology / Q000601:surgery / Q000628:therapy*; D003657:Decision Making; D005080:Exercise Test; D006801:Humans; D008875:Middle Aged; D016312:Treatment Refusal / Q000208:ethnology*; D044465:White People / Q000706:statistics & numerical data