DO PATIENT PREFERENCES CONTRIBUTE TO RACIAL-DIFFERENCES IN CARDIOVASCULAR PROCEDURE USE

OBJECTIVE: To determine whether patient preferences for the use of cor onary revascularization procedures differ between white and black Amer icans. DESIGN: Cross-sectional survey. SETTING: Tertiary care Departme nt of Veterans Affairs hospital. PATIENTS: Outpatients with and withou t known coronary artery disease were interviewed while awaiting appoin tments (n = 272). Inpatients awaiting catheterization were approached the day before the scheduled procedure (n = 80). Overall, 118 blacks a nd 234 whites were included in the study. MEASUREMENTS AND MAIN RESULT S: Patient responses to questions regarding (1) willingness to undergo angioplasty or coronary artery bypass surgery if recommended by their physician and (2) whether they would elect bypass surgery if they wer e in either of two hypothetical scenarios, one in which bypass surgery would improve symptoms but not survival and one in which it would imp rove both symptoms and survival. Blacks were less likely to say they w ould undergo revascularization procedures than whites. However, questi ons dealing with familiarity with the procedure were much stronger pre dictors of a positive attitude toward procedure use. Patients who were not working or over 65 years of age were also less interested in proc edure use. In multivariable analysis race was not a significant predic tor of attitudes toward revascularization except for angioplasty recom mended by their physician. CONCLUSIONS: Racial differences in revascul arization rates may be due in part to differences in patient preferenc es. However, preferences were more closely related to questions assess ing various aspects of familiarity with the procedure. Patients of all races may benefit from improved communication regarding proposed reva scularization. Further research should address this issue in patients contemplating actual revascularization.