Breathlessness may explain heart surgery gap

NEW YORK (Reuters Health) - Doctors appear to be cautious in recommending stents or bypass surgery for heart disease patients with shortness of breath, researchers report. This may explain why blacks with coronary heart disease undergo artery-clearing procedures less often than whites do, because black patients are more likely than whites to have breathlessness.

To see if symptoms and treatment varied between black and white heart patients, Dr. Marilyn Hravnak of the University of Pittsburgh and colleagues interviewed doctors and their patients with coronary heart disease -- 116 blacks and 1080 whites -- at two hospitals in Pittsburgh.

Whites tended to have more severe disease than blacks, with more instances of multiple blockages, while black patients were more likely than whites to report shortness of breath (87 percent versus 72 percent), the team reports in the American Journal of Public Health.

Even among patients with similar severity of heart disease, blacks were still more affected by breathlessness than whites. Other cardiac symptoms were no more common in one race than the other.

Whites were subsequently more likely than blacks to be recommended for revascularization procedures (i.e., to open up clogged arteries), such as coronary bypass grafting or placement of stents (39 percent versus 25 percent). When the researchers looked at all the factors that might account for this, "shortness of breath remained a negative predictor for a recommendation to revascularize."

Hravnak and associates speculate that physicians may consider patients with shortness of breath to have other conditions that would increase the riskiness of revascularization procedures.

SOURCE: American Journal of Public Health, online July 31, 2007.