Race and Heart Attack Treatment
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
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."