Previous research has shown that cardiac procedures and cardiac surgery are performed less frequently in blacks than whites. This pattern was identified even in a recent study based in Veteran's Administration Medical Centers, where economic factors should not have played an important role. The present study examined racial patterns in procedure rates in the Veteran's Administration system in order to identify possible explanations for the previously reported patterns.

Patients from a Veterans Affairs (VA) Center in New York who were referred for cardiac procedures and were presented at a weekly joint cardiology-cardiovascular conference during the period from 1988 to 1996 were included. All patients had already undergone cardiac catheterization. Conference recommendations were made based on data provided by referring cardiologists (age, sex, race, clinical history and results of diagnostic testing). At the time of the conference, data on race were available for 55.3% of the 3,247 patients; information regarding patient race was never explicitly discussed at the time of the conference. (Note that the methods section seems to be inconsistent with regard to the inclusion of patient race information at the conference. The authors specify that race was among the data used to make conference recommendations, and then state that "information regarding the patients' race was never explicitly discussed at the time of the conference.")

Therapeutic cardiac procedures (surgery or percutaneous transluminal coronary angioplasty) were recommended more frequently for Caucasian patients than for African American patients (72.9% versus 64.3%). The procedure was refused by more African American than Caucasian patients (15.4% of African American patients and 8.3% of Caucasian patients refused). This pattern was also true for surgical procedures specifically: 59.8% of Caucasians versus 46.6% of African Americans were recommended surgical procedures, and 20.1% of African Americans and 9.4% of Caucasians refused surgery. However, there were no racial differences in the rate of recommendation or refusal related to coronary artery angioplasty (PTCA). Racial disparities did not significantly change over time (before and after 1992).

There were no racial differences in age, proportion male, diabetes, congestive health failure or exertional angina. Blacks were more likely to have hypertension than whites.

The authors conclude that "these data suggested that differences in the performance of therapeutic invasive cardiac procedures between Caucasian and African American patients are strongly related to a greater reluctance of African Americans to agree to undergo these procedures." They suggest that a possible explanation for patient reluctance may relate to poor communication by and with health care providers.