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Women, minorities, and even children are at risk
Physicians and other researchers say it’s time to change the perception of cardiovascular patients. The myth that heart disease is an ailment that only strikes white males still persists, which can cause people to underestimate their own risk as well as cause doctors not to be as vigilant as they need to be with cardiac treatment for minorities and women. Because chances to control developing heart conditions can go unnoticed, serious diseases like heart failure can occur.
"It’s not a matter of racism," insists George A. Mensah, MD, chief of cardiology and the head of cardiovascular care at Veterans Affairs Medical Center in Augusta, GA. "The thought that doctors are withholding the proper treatment because they don’t want a particular group to get it is nonsense," he says. The discrepancies come from the ways many physicians have been trained, based on outdated concepts of who gets heart disease.
Recent studies have shown blacks receive fewer procedures such as cardiac catheterization and bypass surgery than whites. The reasons vary. One study conducted at the 1996 meeting of the American Academy of Family Practice and the 1997 meeting of the American College of Physicians found doctors did not recommend as many black or female patients for these procedures — although the physicians reviewed cases of white and black men and women who had identical information indicating a procedure should be done. The information included a positive stress test and other indicators to take action, says researcher Kevin A. Schulman, MD, of Georgetown University Medical Center in Washington, DC, so all patients with angina probably should have received follow-up care.
Researchers from the Harvard School of Public Health in Boston recently showed an overall underuse of cardiac procedures in the New York City hospitals they studied. But it was most pronounced in local facilities that tested for cardiac problems but did not offer treatment on site. A patient was more likely to receive a cardiac procedure if he or she was tested at a medical center that could deal with the problem on site.
The report notes if patients at off-site centers have to seek care from a second facility, they face stringent referral guidelines and can lose motivation to continue their care. Because more minorities such as African-Americans may be using these local hospitals, the differences in the numbers of procedures could be falling along racial lines.
Even with studies that control factors such as diabetes, hypertension, age, insurance status, and socioeconomic issues, evidence is mounting that conditions such as heart failure may have distinct natural histories according to the race of the patient.
But getting the word out has been a slow process, says Mensah, an African-American. Changing the way physicians think about heart disease means providing doctors with updated information at every level of their professional careers from medical students to senior faculty.
And when it comes to teaching doctors about who is at risk of heart disease, some pediatricians would like to add a chapter to the curriculum. Their current studies suggest the risks seen in adults can be traced back to childhood.
Major warning signs — diabetes, obesity, left-ventricular mass, and cholesterol levels — can appear long before a patient grows up.
Children are already forming harmful habits such as smoking and eating high-fat diets. Clinicians say starting young patients on therapies to treat the medical conditions and offering counseling on diet and lifestyle can do a lot to keep heart disease from happening in the first place.
The good news on how medicine handles racial issues, says Mensah, is it can be improved. Others note patients will have to be more vocal until doctors can do a better job of shepherding all of their patients through cardiovascular care. The following articles provide more details.