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Symptom expression in coronary heart disease and revascularization recommendations for black and white patients. Am J Public Health 2007 Sep;97(9):1701-8

Date

03/03/2007

Pubmed ID

17329655

Pubmed Central ID

PMC1963307

DOI

10.2105/AJPH.2005.084103

Scopus ID

2-s2.0-34548480706 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

OBJECTIVES: 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.

Author List

Hravnak M, Whittle J, Kelley ME, Sereika S, Good CB, Ibrahim SA, Conigliaro J

Author

Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Angina Pectoris
Cardiac Catheterization
Chest Pain
Coronary Artery Bypass
Coronary Disease
Coronary Stenosis
Decision Making
Dyspnea
Fatigue
Female
Humans
Interviews as Topic
Male
Middle Aged
Myocardial Revascularization
Pennsylvania
Practice Patterns, Physicians'
Referral and Consultation