title: Apparent racial disparity in the utilization of invasive testing for risk assessment of cardiac patients undergoing noncardiac surgery.
abstract: BACKGROUND
  Studies on racial disparity in the use of cardiac diagnostic procedures are limited because they were conducted in the acute clinical setting without control for patient knowledge and emotional state or used models not controlling for racism. Using the setting (model) of elective evaluation of known, stable, cardiac patients undergoing noncardiac surgery, where the surgeon/anesthesiologist's personal interest precludes expression of potential racial bias, we assessed for racial differences in the utilization of diverse cardiac diagnostic procedures for risk assessment and optimization.
  
  
  METHODS
  This is a secondary analysis of data from 314 consecutive patients [92 (29%) African-American, 222 (71%) Caucasian] with coronary artery disease (CAD), cardiomyopathy (ejection fraction <45%), or treatment-requiring arrhythmias, who underwent noncardiac surgery.
  
  
  RESULTS
  The incidence of angina, prior myocardial infarction, and ischemic cardiomyopathy was higher in Caucasians (75%, 68%, and 164%, P<.0001, respectively), while nonischemic cardiomyopathy was more prevalent among African-Americans (84%, P<.0001). While, multivariately, African race predicted underuse of coronary angiography (odds ratio: 0.10, 95% confidence interval: 0.04-0.26, P<.0001), this predictor was eliminated when presence of CAD plus cardiomyopathy was factored in as a surrogate of severity. The use of noninvasive cardiac procedures and the 30-day mortality and morbidity did not differ by race.
  
  
  CONCLUSIONS
  In a racism-proof model of preoperative evaluation of stable cardiac veterans, the racial disparity in the use of invasive procedures was related to epidemiologic differences. In addition, the parity in mortality and morbidity corroborates no underuse of diagnostic procedures among African-Americans.
authors.affiliation: Section of Cardiology, Medical Service, WJB Dorn Veterans' Affairs Medical Center, the WJB Dorn Research Institute, Columbia, SC, USA.
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Hassapoyannes
authors.forename: Dan-Victor
authors.initials: DV
authors.lastname: Giurgiutiu
authors.forename: Gregory
authors.initials: G
authors.lastname: Eaves
authors.forename: Mohammad-Reza
authors.initials: MR
authors.lastname: Movahed
mesh_terms: D044383:Black People; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D044465:White People; D001741:Black or African American