Apparent racial disparity in the utilization of invasive testing for risk assessment of cardiac patients undergoing noncardiac surgery

Hassapoyannes, Constantine A.; Giurgiutiu, Dan-Victor; Eaves, Gregory; Movahed, Mohammad-Reza

doi:10.1016/j.carrev.2005.12.001

« Previous Next »Cardiovascular Revascularization Medicine
Volume 7, Issue 2 , Pages 64-69, April 2006

Apparent racial disparity in the utilization of invasive testing for risk assessment of cardiac patients undergoing noncardiac surgery

Constantine A. Hassapoyannes
- Section of Cardiology, Medical Service, WJB Dorn Veterans' Affairs Medical Center, the WJB Dorn Research Institute, Columbia, SC, USA
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
- Department of Physiology, University of South Carolina School of Medicine, Columbia, SC, USA
Dan-Victor Giurgiutiu
- Section of Cardiology, Medical Service, WJB Dorn Veterans' Affairs Medical Center, the WJB Dorn Research Institute, Columbia, SC, USA
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
- Department of Physiology, University of South Carolina School of Medicine, Columbia, SC, USA
Gregory Eaves
- Section of Cardiology, Medical Service, WJB Dorn Veterans' Affairs Medical Center, the WJB Dorn Research Institute, Columbia, SC, USA
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
- Department of Physiology, University of South Carolina School of Medicine, Columbia, SC, USA
Mohammad-Reza Movahed
- Department of Medicine, University of California, Irvine, CA, USA
- Corresponding author. Division of Cardiology, 101 The City Drive, Bldg 53 Room 100, Orange, CA 92868, USA. Tel.: +1 714 456 5427; fax: +1 714 456 8895.

Received 18 October 2005; received in revised form 2 December 2005; accepted 2 December 2005.

Abstract

Background

Studies on racial disparity in the use of cardiac diagnostic procedures are limited because they were conducted in the acute clinical setting without control for patient knowledge and emotional state or used models not controlling for racism. Using the setting (model) of elective evaluation of known, stable, cardiac patients undergoing noncardiac surgery, where the surgeon/anesthesiologist's personal interest precludes expression of potential racial bias, we assessed for racial differences in the utilization of diverse cardiac diagnostic procedures for risk assessment and optimization.

Methods

This is a secondary analysis of data from 314 consecutive patients [92 (29%) African-American, 222 (71%) Caucasian] with coronary artery disease (CAD), cardiomyopathy (ejection fraction <45%), or treatment-requiring arrhythmias, who underwent noncardiac surgery.

Results

The incidence of angina, prior myocardial infarction, and ischemic cardiomyopathy was higher in Caucasians (75%, 68%, and 164%, P<.0001, respectively), while nonischemic cardiomyopathy was more prevalent among African-Americans (84%, P<.0001). While, multivariately, African race predicted underuse of coronary angiography (odds ratio: 0.10, 95% confidence interval: 0.04–0.26, P<.0001), this predictor was eliminated when presence of CAD plus cardiomyopathy was factored in as a surrogate of severity. The use of noninvasive cardiac procedures and the 30-day mortality and morbidity did not differ by race.

Conclusion

In a racism-proof model of preoperative evaluation of stable cardiac veterans, the racial disparity in the use of invasive procedures was related to epidemiologic differences. In addition, the parity in mortality and morbidity corroborates no underuse of diagnostic procedures among African-Americans.

Keywords: Ethnic groups, Coronary angiography, Preoperative care