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Black Heart Patients Have Poorer Quality of Life

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Duke Health News 919-660-1306

ATLANTA -- Duke University Medical Center researchers have
demonstrated for the first time that African-American heart
patients tend to suffer worse symptoms and be more functionally
impaired as a result of their heart disease.

The new finding is important because it builds on previous
studies demonstrating that African-Americans appear less likely
to receive procedures to re-establish blood supply to ailing
hearts and that they have higher mortality rates.

Using a standardized test that measures how disease affects
everyday living, the Duke researchers found a significant
difference between the scores reported by African-Americans
compared to white heart patients, above and beyond what would
be expected given the known disparities in care and outcome.
African-Americans also reported higher levels of chest pain
(angina).

While the researchers cannot explain why this racial
disparity exists, they emphasize that their findings should
open up a new area for aggressive research activity.

Although we knew there are racial disparities in care, we
did not know how these differences affected patients' symptoms
and functional status," said Padma Kaul, Ph.D., a postdoctoral
fellow at the Duke Clinical Research Institute. "This is the
first time racial differences in symptoms and quality of life
has been quantified."

The results of the Duke team's analysis were prepared for
presentation today (March 19) at the 51st annual scientific
sessions of the American College of Cardiology.

For the study, the researchers tested 1,392 (1,150 white,
242 African-American) patients who were diagnosed with coronary
artery disease after a cardiac catheterization at Duke
University Hospital between August 1998 and April 2001.

At enrollment, patients took a standardized test known as
the SF-36, a questionnaire describing such factors as
perceptions of general health, mental health and social
functioning. It also measures how patients feel their illness
has impacted their everyday mental and physical activities. The
test has been used for years for different diseases and is
considered a reliable measure of patients' perceptions of their
quality of life. Final results are based on a 100-point
scale.

Patients also took the Seattle Angina Questionnaire, a
standard test that gauges patients' perceptions of the severity
of their angina. Patients retook both tests six months
later.

At cardiac catheterization, African-Americans had lower
functional status scores and similar symptoms as whites. In
this study population, 60 percent of the African-Americans
received an angioplasty or bypass surgery, compared to 72
percent for whites, a statistically significant disparity. By
six months, function outcomes in both cohorts improved,
however, African-Americans continued to report worse functional
status and angina symptoms compared to whites. These
differences persisted even after adjusting for baseline
characteristics and revascularization status.

Said Duke cardiologist Eric Peterson, M.D., "While there
have been past studies looking at the differences in health
care delivery between African-Americans and whites, this is the
first to actually measure how having heart disease impacts on
everyday life."

Peterson is senior member of the research team who has
published widely on the issue of racial disparities in health
care.

"The fact that African-Americans report that their symptoms
and functional outcomes are worse is a very important finding,"
he continued. "What is more difficult is understanding exactly
why. But this is a very important issue that definitely needs
to be addressed to ensure that all patients benefit from
treatments."

There are some hypotheses that might explain the
disparities, Peterson said, but so far, nothing has been
proven. It might be, Peterson said, that the natural course of
heart disease might be different in African-Americans than
whites or their response to therapy.

He also said it was possible that African-Americans and
whites might have differing perceptions of their own health and
personal situations. Even though the team measured these items
at baseline and at six months, cultural differences still could
explain some of the difference in perceptions.

Other potential factors include those that occur once
patients leave the hospital, such as compliance with
prescriptions given at discharge, and whether or not patients
adjust their lifestyles in response to their heart disease. For
Kaul, these findings should influence the design of future
cardiology studies.

"In the past, the primary measurement or endpoint has been
death or heart attack, but with the advances in medicine there
are fewer and fewer of these events," she said. "We should be
looking at improving quality of life and functional status, and
if we find that African-Americans do worse because of medical
practice patterns, we need to educate providers about all the
treatment options."

Kaul's analysis was supported by the Duke Clinical Research
Institute. Barbara Lytle of Duke was also part of the research
team.

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