The effect of race on the referral process for invasive cardiac procedures

Coronary artery disease is the leading cause of death in the United States. Blacks are more likely than whites to experience premature disease, and th ey have poorer prognosis after acute myocardial infarction. Multiple studie s have demonstrated that blacks are less likely to be referred for certain invasive cardiac procedures. Few studies have examined the effect of race o n physician and patient decision making in referrals for cardiac procedures . The authors present a framework for the complex series of steps involved in obtaining invasive cardiac care. Patient race can affect each of these s teps, and differences in physician and patient race may be a particular imp ediment to effective communication about symptoms and preferences and to th e establishment of a therapeutic partnership. The potential role of communi cation in race-discordant physician-patient relationships suggests a need f or more research in physician decision making and for efforts to promote cu ltural competency as a core component of medical education.