RACIAL-DIFFERENCES IN PERFORMANCE OF INVASIVE CARDIAC PROCEDURES IN ADEPARTMENT-OF-VETERANS-AFFAIRS MEDICAL-CENTER

Racial differences have recently been described in hospital practice, most notably with regard to cardiac procedure utilization. To evaluate the possible reasons behind these differences, we analyzed statistics generated from a surgical referral conference at a large, tertiary ca re Veterans Affairs hospital between the years 1988 and 1996. In this setting, there is no financial incentive for physicians to recommend o r perform invasive procedures, as all physicians are salaried employee s of the Veterans Administration. Furthermore, all patients presented at conference have already had cardiac catheterization and are felt to be potential candidates for surgery or angioplasty. Cardiac therapeut ic procedures (surgery or percutaneous transluminal coronary angioplas ty) were recommended for 1075 of 1474 (72.9%) Caucasian patients and 2 07 of 322 (64.3%) African-American patients (odds ratio 1.497, 95% con fidence interval 1.160 to 1.932, p = 0.0022). Of those patients presen ted with the option of an invasive procedure, 32 of 207 (15.4%) Africa n-American patients and 89 of 1075 (8.3%) Caucasian patients refused a ny invasive procedure (odds ratio 2.026, 95% confidence interval 1.311 to 3.130, p = 0.0025). We conclude that reluctance by African-America n patients to undergo invasive cardiac procedures may help explain obs erved disparities in race-related cardiac care. (C) 1997 Elsevier Scie nce Inc.