INFLUENCE OF GENDER, PACE, AND EDUCATION ON PATIENT PREFERENCES AND RECEIPT OF CARDIAC CATHETERIZATIONS AMONG CORONARY-CARE UNIT PATIENTS

The extent to which a preference for less aggressive care explains the lower rate of invasive cardiac services for women and African-America ns is unknown. A prospective observational study of 272 patients admit ted to the coronary care unit was conducted at a tertiary referral tea ching hospital and a community teaching hospital. In stepwise multivar iate analysis, having less than a college education, poor cardiac func tion, not having undergone a previous cardiac catheterization, being a patient in a nonreferral community hospital, and current smoking were positively associated with a patient's stating that he or she would d isagree with a physician's recommendation for a cardiac catheterizatio n. The stepwise multivariate model with cardiac catheterization as the dependent variable indicated that being a patient in a referral medic al center, patient willingness to accept a physician's recommendation for a cardiac catheterization, severe heart disease, and having attend ed high school were predictive. Women did not differ from men in their preference for or receipt of cardiac catheterization. Patients in the coronary care unit. with lower levels of education were less likely t o undergo cardiac catheterization. This association was only partly ex plained by less educated patients' being less willing to accept a phys ician's recommendation to undergo cardiac catheterization. (C) 1996 by Excerpta Medica, Inc.