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Race and Heart Attack Treatment

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WebMD Health News

April 12, 2000 (Los Angeles) -- Black patients suffering a heart attack are significantly less likely than whites to receive potentially life-saving therapy, according to a study in the April 13 issue of the New England Journal of Medicine. The reason for this disparity is unknown, but the authors suggest there may be differences in symptoms among blacks and whites.

In a press release about the study, lead author John G. Canto, MD, emphasizes that "It's not a case of doctors saying 'I'm not going to treat you because you're black.'" Rather, he says, "The diagnosis [in blacks] is less clear for various reasons, including slight differences in diagnostic testing and symptoms. Apparently, blacks may have some clinical characteristics that differ from those of whites, thus making diagnosis and decision to treat with drug therapy more difficult for doctors."

Canto and his colleagues from the University of Alabama at Birmingham (UAB) reviewed the medical records of almost 235,000 Medicare patients who experienced a heart attack. From that list, they identified over 26,500 white and black patients who were eligible for a treatment known as reperfusion therapy, in which doctors administer a drug designed to open clogged arteries. They grouped those patients according to race and sex and determined who was most likely to receive that therapy.

White men were most likely, followed by white women, black men, and black women. Overall, only 57% of the study patients who were eligible to receive reperfusion therapy actually received it. Within each race, the women were as likely as the men to undergo reperfusion.

"Most surprising to me was the lack of gender effect," says co-author Catarina I. Kiefe, MD, PhD. She tells WebMD that "we did expect more of a men vs. women effect." As for the racial differences, she says, "We were disappointed but not surprised."

There is some evidence that blacks are less likely to have chest pain, which is one of the main determinants of who will receive reperfusion therapy. The investigators write, "Although only patients who presented with chest pain were included in our analysis, it is possible that other clinically related factors may have decreased suspicion on the part of the physician that a black patient was having a [heart attack]."

Lynn Smaha, MD, president of the American Heart Association, adds in a statement that readings of an electrocardiogram (EKG), which measures electrical activity in the heart, may not be as accurate in blacks as they are in whites. "Confirming that a heart attack has occurred may be more difficult in blacks than whites because it is harder to interpret the EKG findings," he says.

Kiefe, who is professor of medicine at UAB and director of the Center for Outcomes and Effectiveness Research and Education, urges black patients not to assume that they automatically will receive worse or different treatment should they suffer a heart attack. "These findings need to be interpreted with much caution," she says. "The most important point here is that more study is needed."

For consumers who are concerned, she says, "An educated consumer is always a better patient. Learning as much as you can about [heart disease] and asking questions about things you don't understand are always helpful."

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