Symptom expression in coronary heart disease and revascularization recommendations for black and white patients

Am J Public Health. 2007 Sep;97(9):1701-8. doi: 10.2105/AJPH.2005.084103. Epub 2007 Feb 28.


Objectives: We examined whether symptoms of coronary heart disease vary between Black and White patients with coronary heart disease, whether presenting symptoms affect physicians' revascularization recommendations, and whether the effect of symptoms upon recommendations differs in Black and White patients.

Methods: We interviewed Black and White patients in Pittsburgh in 1997 to 1999 who were undergoing elective coronary catheterization. We interviewed them regarding their symptoms, and we interviewed their cardiologist decision-makers regarding revascularization recommendations. We obtained coronary catheterization results by chart review.

Results: Black and White patients (N=1196; 9.7% Black) expressed similar prevalence of chest pain, angina equivalent, fatigue, and other symptoms, but Black patients had more shortness of breath (87% vs 72%, P=.001). When we considered only those patients with significant stenosis (n=737, 7.1% Black) and controlled for race, age, gender, and number of stenotic vessels, those who expressed shortness of breath were less likely to be recommended for revascularization (odds ratio=0.535; 95% confidence interval=0.375, 0.762; P<.001), but there was no significant interaction with race.

Conclusions: Black patients reported shortness of breath more frequently than did White subjects. Shortness of breath was a negative predictor for revascularization for all patients with significant stenosis, but there was no difference in the recommendations by symptom by race.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • African Americans / statistics & numerical data*
  • Aged
  • Angina Pectoris / ethnology
  • Angina Pectoris / etiology
  • Cardiac Catheterization
  • Chest Pain / ethnology
  • Chest Pain / etiology
  • Coronary Artery Bypass / statistics & numerical data
  • Coronary Disease / diagnosis*
  • Coronary Disease / ethnology*
  • Coronary Disease / physiopathology
  • Coronary Stenosis / diagnosis
  • Coronary Stenosis / ethnology
  • Decision Making
  • Dyspnea / ethnology
  • Dyspnea / etiology*
  • Fatigue / ethnology
  • Fatigue / etiology
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Myocardial Revascularization / statistics & numerical data
  • Pennsylvania
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Referral and Consultation / statistics & numerical data*
  • Whites / statistics & numerical data*