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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2005.084103v1 AJPH.2005.084103v2 97/9/1701    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Hravnak, M. Articles by Conigliaro, J. Search for Related Content PubMed PubMed Citation Articles by Hravnak, M. Articles by Conigliaro, J. Related Collections Other Chronic Disease African Americans/Blacks Other Race/Ethnicity Cardiovascular Disease

Marilyn Hravnak, PhD, RN, ACNP-BC, Jeff Whittle, MD, MPH, Mary E. Kelley, PhD, Susan Sereika, PhD, Chester B. Good, MD, MPH, Said A. Ibrahim, MD, MPH and Joseph Conigliaro, MD, MPH

Marilyn Hravnak, Chester B. Good, and Said A. Ibrahim are with the Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Health System, University of Pittsburgh, Pittsburgh, Pa. Jeff Whittle is with the University of Kansas Medical Center, Kansas City. Mary E. Kelley is with Emory University, Atlanta, Ga. Susan Sereika is with the Center for Research and Evaluation, School of Nursing, University of Pittsburgh, Pittsburgh. Joseph Conigliaro is with the University of Kentucky Medical Center, Lexington.

Correspondence: Requests for reprints should be sent to Marilyn Hravnak RN, PhD, School of Nursing, University of Pittsburgh, 3500 Victoria Street, 336 Victoria Building, Pittsburgh PA 15261 (e-mail: mhra{at}pitt.edu).

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.

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