Race and patient refusal of invasive cardiac procedures

Research output: Contribution to journalReview article

Howard S. Gordon, Debora A. Paterniti, Nelda Wray

OBJECTIVE: To determine whether patients' decisions are an important determinant of nonuse of invasive cardiac procedures and whether decisions vary by race. DESIGN: Observational prospective cohort. PARTICIPANTS: Patients (N = 681) enrolled at the exercise treadmill or the cardiac catheterization laboratories at a large Veterans Affairs hospital. MEASURES: Doctors' recommendations and patients' decisions were determined by both direct observation of doctor and patient verbal behavior and by review of medical charts. Performance of coronary angiography, angioplasty, and bypass surgery were determined by chart review for a minimum of 3 months follow-up. RESULTS: Coronary angiography was recommended after treadmill testing for 83 of 375 patients and 72 patients underwent angiography. Among 306 patients undergoing angiography, recommendations for coronary angioplasty or bypass surgery were given to 113 and 45 patients and were completed for 98 and 33 patients, respectively. Recommendations were not significantly different by race. However, 4 of 83 (4.8%) patients declined or did not return for recommended angiograms and this was somewhat more likely among black and Hispanic patients, compared with white patients (13% and 33% vs 2%; P = .05). No patients declined angioplasty and 2 of 45 (4.4%) patients declined or did not return for recommended bypass surgery, Other recommended procedures were not completed after further medical evaluation (n = 32). There was no difference (P > .05) by race/ethnicity in doctor-level reasons for nonreceipt of recommended invasive cardiac procedures. CONCLUSIONS: Patient decisions to decline recommended invasive cardiac procedures were infrequent and may explain only a small fraction of racial disparities in the use of invasive cardiac procedures.

Original languageEnglish (US)
Pages (from-to)962-966
Number of pages5
JournalJournal of General Internal Medicine
Volume19
Issue number9
DOIs
StatePublished - Sep 1 2004

PMID: 15333061

PMCID: PMC1492524

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Race and patient refusal of invasive cardiac procedures. / Gordon, Howard S.; Paterniti, Debora A.; Wray, Nelda.

In: Journal of General Internal Medicine, Vol. 19, No. 9, 01.09.2004, p. 962-966.

Research output: Contribution to journalReview article

Harvard

Gordon, HS, Paterniti, DA & Wray, N 2004, 'Race and patient refusal of invasive cardiac procedures' Journal of General Internal Medicine, vol. 19, no. 9, pp. 962-966. https://doi.org/10.1111/j.1525-1497.2004.30131.x

APA

Gordon, H. S., Paterniti, D. A., & Wray, N. (2004). Race and patient refusal of invasive cardiac procedures. Journal of General Internal Medicine, 19(9), 962-966. https://doi.org/10.1111/j.1525-1497.2004.30131.x

Vancouver

Gordon HS, Paterniti DA, Wray N. Race and patient refusal of invasive cardiac procedures. Journal of General Internal Medicine. 2004 Sep 1;19(9):962-966. https://doi.org/10.1111/j.1525-1497.2004.30131.x

Author

Gordon, Howard S. ; Paterniti, Debora A. ; Wray, Nelda. / Race and patient refusal of invasive cardiac procedures. In: Journal of General Internal Medicine. 2004 ; Vol. 19, No. 9. pp. 962-966.

BibTeX

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title = "Race and patient refusal of invasive cardiac procedures",
abstract = "OBJECTIVE: To determine whether patients' decisions are an important determinant of nonuse of invasive cardiac procedures and whether decisions vary by race. DESIGN: Observational prospective cohort. PARTICIPANTS: Patients (N = 681) enrolled at the exercise treadmill or the cardiac catheterization laboratories at a large Veterans Affairs hospital. MEASURES: Doctors' recommendations and patients' decisions were determined by both direct observation of doctor and patient verbal behavior and by review of medical charts. Performance of coronary angiography, angioplasty, and bypass surgery were determined by chart review for a minimum of 3 months follow-up. RESULTS: Coronary angiography was recommended after treadmill testing for 83 of 375 patients and 72 patients underwent angiography. Among 306 patients undergoing angiography, recommendations for coronary angioplasty or bypass surgery were given to 113 and 45 patients and were completed for 98 and 33 patients, respectively. Recommendations were not significantly different by race. However, 4 of 83 (4.8{\%}) patients declined or did not return for recommended angiograms and this was somewhat more likely among black and Hispanic patients, compared with white patients (13{\%} and 33{\%} vs 2{\%}; P = .05). No patients declined angioplasty and 2 of 45 (4.4{\%}) patients declined or did not return for recommended bypass surgery, Other recommended procedures were not completed after further medical evaluation (n = 32). There was no difference (P > .05) by race/ethnicity in doctor-level reasons for nonreceipt of recommended invasive cardiac procedures. CONCLUSIONS: Patient decisions to decline recommended invasive cardiac procedures were infrequent and may explain only a small fraction of racial disparities in the use of invasive cardiac procedures.",
keywords = "Coronary artery disease, Ethnic groups, Patient acceptance of health care, Racial variation, Treatment refusal",
author = "Gordon, {Howard S.} and Paterniti, {Debora A.} and Nelda Wray",
year = "2004",
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doi = "10.1111/j.1525-1497.2004.30131.x",
language = "English (US)",
volume = "19",
pages = "962--966",
journal = "Journal of General Internal Medicine",
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RIS

TY - JOUR

T1 - Race and patient refusal of invasive cardiac procedures

AU - Gordon, Howard S.

AU - Paterniti, Debora A.

AU - Wray, Nelda

PY - 2004/9/1

Y1 - 2004/9/1

N2 - OBJECTIVE: To determine whether patients' decisions are an important determinant of nonuse of invasive cardiac procedures and whether decisions vary by race. DESIGN: Observational prospective cohort. PARTICIPANTS: Patients (N = 681) enrolled at the exercise treadmill or the cardiac catheterization laboratories at a large Veterans Affairs hospital. MEASURES: Doctors' recommendations and patients' decisions were determined by both direct observation of doctor and patient verbal behavior and by review of medical charts. Performance of coronary angiography, angioplasty, and bypass surgery were determined by chart review for a minimum of 3 months follow-up. RESULTS: Coronary angiography was recommended after treadmill testing for 83 of 375 patients and 72 patients underwent angiography. Among 306 patients undergoing angiography, recommendations for coronary angioplasty or bypass surgery were given to 113 and 45 patients and were completed for 98 and 33 patients, respectively. Recommendations were not significantly different by race. However, 4 of 83 (4.8%) patients declined or did not return for recommended angiograms and this was somewhat more likely among black and Hispanic patients, compared with white patients (13% and 33% vs 2%; P = .05). No patients declined angioplasty and 2 of 45 (4.4%) patients declined or did not return for recommended bypass surgery, Other recommended procedures were not completed after further medical evaluation (n = 32). There was no difference (P > .05) by race/ethnicity in doctor-level reasons for nonreceipt of recommended invasive cardiac procedures. CONCLUSIONS: Patient decisions to decline recommended invasive cardiac procedures were infrequent and may explain only a small fraction of racial disparities in the use of invasive cardiac procedures.

AB - OBJECTIVE: To determine whether patients' decisions are an important determinant of nonuse of invasive cardiac procedures and whether decisions vary by race. DESIGN: Observational prospective cohort. PARTICIPANTS: Patients (N = 681) enrolled at the exercise treadmill or the cardiac catheterization laboratories at a large Veterans Affairs hospital. MEASURES: Doctors' recommendations and patients' decisions were determined by both direct observation of doctor and patient verbal behavior and by review of medical charts. Performance of coronary angiography, angioplasty, and bypass surgery were determined by chart review for a minimum of 3 months follow-up. RESULTS: Coronary angiography was recommended after treadmill testing for 83 of 375 patients and 72 patients underwent angiography. Among 306 patients undergoing angiography, recommendations for coronary angioplasty or bypass surgery were given to 113 and 45 patients and were completed for 98 and 33 patients, respectively. Recommendations were not significantly different by race. However, 4 of 83 (4.8%) patients declined or did not return for recommended angiograms and this was somewhat more likely among black and Hispanic patients, compared with white patients (13% and 33% vs 2%; P = .05). No patients declined angioplasty and 2 of 45 (4.4%) patients declined or did not return for recommended bypass surgery, Other recommended procedures were not completed after further medical evaluation (n = 32). There was no difference (P > .05) by race/ethnicity in doctor-level reasons for nonreceipt of recommended invasive cardiac procedures. CONCLUSIONS: Patient decisions to decline recommended invasive cardiac procedures were infrequent and may explain only a small fraction of racial disparities in the use of invasive cardiac procedures.

KW - Coronary artery disease

KW - Ethnic groups

KW - Patient acceptance of health care

KW - Racial variation

KW - Treatment refusal

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UR - http://www.scopus.com/inward/citedby.url?scp=4544286090&partnerID=8YFLogxK

U2 - 10.1111/j.1525-1497.2004.30131.x

DO - 10.1111/j.1525-1497.2004.30131.x

M3 - Review article

VL - 19

SP - 962

EP - 966

JO - Journal of General Internal Medicine

T2 - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 9

ER -

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