Symptom expression in coronary heart disease and revascularization recommendations for black and white patients.
OBJECTIVE
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.


METHODS
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.


RESULTS
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<.001), but there was no significant interaction with race.


CONCLUSIONS
Black patients reported shortness of breath more frequently than did White subjects. Shortness of breath was a negative predictor for revascularization for all patients with significant stenosis, but there was no difference in the recommendations by symptom by race.
Hravnak
Marilyn
M
Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Health System, University of Pittsburgh, Pittsburgh, Pa 15261, USA. mhra@pitt.edu
Whittle
Jeff
J
Kelley
Mary E
ME
Sereika
Susan
S
Good
Chester B
CB
Ibrahim
Said A
SA
Conigliaro
Joseph
J
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000787:Angina Pectoris / Q000208:ethnology / Q000209:etiology; D006328:Cardiac Catheterization; D002637:Chest Pain / Q000208:ethnology / Q000209:etiology; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000175:diagnosis* / Q000208:ethnology* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000175:diagnosis / Q000208:ethnology; D003657:Decision Making; D004417:Dyspnea / Q000208:ethnology / Q000209:etiology*; D005221:Fatigue / Q000208:ethnology / Q000209:etiology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D010414:Pennsylvania; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*