Racial differences in the use of cardiac catheterization after acute myocardial infarction.

BACKGROUND Several studies have reported that black patients are less likely than white patients to undergo cardiac catheterization after acute myocardial infarction. The role of the race of the physician in this pattern is unknown. METHODS We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries hospitalized for acute myocardial infarction in 1994 and 1995, to evaluate whether differences between black patients and white patients in the use of cardiac catheterization within 60 days after acute myocardial infarction varied according to the race of their attending physician. RESULTS Our study cohort consisted of 35,676 white and 4039 black patients with acute myocardial infarction who were treated by 17,550 white and 588 black physicians. Black patients had lower rates of cardiac catheterization than white patients, regardless of whether their attending physician was white (rate of catheterization, 38.4 percent vs. 45.7 percent; P< 0.001) or black (38.2 percent vs. 49.6 percent, P<0.001). We did not find a significant interaction between the race of the patients and the race of the physicians in the use of cardiac catheterization. The adjusted mortality rate among black patients was lower than or similar to that among white patients for up to three years after the infarction. CONCLUSIONS Racial differences in the use of cardiac catheterization are similar among patients treated by white physicians and those treated by black physicians, suggesting that this pattern of care is independent of the race of the physician.

[1]  J. Eisenberg.  Sociologic influences on decision-making by clinicians. , 1979, Annals of internal medicine.

[2]  H. White.  A Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity , 1980 .

[3]  J. Goodwin,et al.  Patient Characteristics That Influence Physician Behavior , 1982, Medical care.

[4]  T. Rice,et al.  The extent of ownership and the characteristics of Medicare supplemental policies. , 1985, Inquiry : a journal of medical care organization, provision and financing.

[5]  D. Lackland,et al.  Acute myocardial infarction: period prevalence, case fatality, and comparison of black and white cases in urban and rural areas of South Carolina. , 1985, American heart journal.

[6]  E. Ford,et al.  In-hospital mortality rates from acute myocardial infarction by race in U.S. hospitals: findings from the National Hospital Discharge Survey. , 1987, Circulation.

[7]  S. Willich,et al.  Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women. , 1987, Journal of the American College of Cardiology.

[8]  B. Simmons,et al.  Myocardial infarction among black patients: poor prognosis after hospital discharge. , 1988, Annals of internal medicine.

[9]  A. Epstein,et al.  Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. , 1989, JAMA.

[10]  B. McNeil,et al.  Acute myocardial infarction in the Medicare population. Process of care and clinical outcomes. , 1992, JAMA.

[11]  David W. Smith,et al.  Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project. , 1993, The New England journal of medicine.

[12]  J. Whittle,et al.  Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. , 1993, The New England journal of medicine.

[13]  F. Harrell,et al.  Continuing evolution of therapy for coronary artery disease. Initial results from the era of coronary angioplasty. , 1994, Circulation.

[14]  E. Peterson,et al.  Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs. , 1994, JAMA.

[15]  G. Cutter,et al.  Diagnoses, symptoms, and attribution of symptoms among black and white inpatients admitted for coronary heart disease. , 1994, American journal of public health.

[16]  D. Mirvis,et al.  Variation in utilization of cardiac procedures in the Department of Veterans Affairs health care system: effect of race. , 1994, Journal of the American College of Cardiology.

[17]  J Col,et al.  Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators. , 1995, Circulation.

[18]  M. Casper,et al.  Race and sex differences in rates of invasive cardiac procedures in US hospitals. Data from the National Hospital Discharge Survey. , 1995, Archives of internal medicine.

[19]  K. Kenward.  The scope of the data available in the AMA's Physician Masterfile. , 1996, American journal of public health.

[20]  E. Braunwald,et al.  Influence of race, sex, and age on management of unstable angina and non-Q-wave myocardial infarction: The TIMI III registry. , 1996 .

[21]  S. Sedlis,et al.  Racial differences in performance of invasive cardiac procedures in a Department of Veterans Affairs Medical Center. , 1997, Journal of clinical epidemiology.

[22]  R. Califf,et al.  Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? , 1997, The New England journal of medicine.

[23]  J. Whittle,et al.  Do Patient Preferences Contribute to Racial Differences in Cardiovascular Procedure Use? , 1997, Journal of general internal medicine.

[24]  D. K. Martin,et al.  Examination of racial differences in management of cardiovascular disease. , 1997, Journal of the American College of Cardiology.

[25]  J. Zhang,et al.  What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. , 1998, JAMA.

[26]  W. Rogers,et al.  Management and outcomes for black patients with acute myocardial infarction in the reperfusion era , 1998 .

[27]  N. Powe,et al.  Race, gender, and partnership in the patient-physician relationship. , 1999, JAMA.

[28]  Harlan M. Krumholz,et al.  Improving the Quality of Care for Medicare Patients with Acute Myocardial Infarction: Results from the Cooperative Cardiovascular Project , 1999 .

[29]  R. Summers,et al.  Prevalence of atypical chest pain descriptions in a population from the southern United States. , 1999, The American journal of the medical sciences.

[30]  H. Krumholz,et al.  Comparing AMI mortality among hospitals in patients 65 years of age and older: evaluating methods of risk adjustment. , 1999, Circulation.

[31]  K A Schulman,et al.  The effect of race and sex on physicians' recommendations for cardiac catheterization. , 1999, The New England journal of medicine.

[32]  Robert Woolard,et al.  Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department , 2000 .

[33]  K. Fiscella,et al.  Racial and ethnic disparities in perceptions of physician style and trust. , 2000, Archives of family medicine.

[34]  M. van Ryn,et al.  The effect of patient race and socio-economic status on physicians' perceptions of patients. , 2000, Social science & medicine.