Among patients diagnosed with serious coronary disease who were followed for an average nine years, the researchers found that blacks have had a 36 percent survival rate while whites have had a 46 percent survival rate.
The researchers said the disparity can be partially by the findings that blacks tend to have higher rates of other medical conditions, which can complicate or contribute to heart problems, and that blacks do not receive coronary artery bypass surgery as often. But the researchers stressed that other unproven factors almost certainly are involved and that further research is needed to identify them and quantify their contributions.
"As prevention becomes a key point of emphasis in treating heart disease, it is vitally important to identify risk factors and to act on them," said cardiology fellow Kevin Thomas, M.D., who reported the results of the analysis on Sunday, Nov. 12, at the annual scientific sessions of the American Heart Association, in Chicago.
The study was supported by a young investigator award from the Association of Black Cardiologists and the Duke Clinical Research Institute.
"Past studies from which risk factors have been derived provide great information about heart disease in white men, but the studies have included few minorities and women," Thomas said. "Cardiovascular disease is the leading cause of death for blacks and whites in the United States, and yet there is a paucity of information on the long-term prognosis for blacks."
For the analysis, Thomas and colleagues consulted the Duke Database for Cardiovascular Disease, a compilation of data on heart patients who come to Duke University Medical Center for diagnosis and treatment. The team analyzed the outcomes of 21,054 patients seen between 1986 and 2004 and found to have serious coronary artery disease. Of those patients, 3,177 were black.
In general, the black patients tended to be younger and more often female, and they had higher rates of hypertension, diabetes, heart failure or previous heart attacks, Thomas said. After the team statistically accounted for those patient characteristics, the disparity in death rates persisted, Thomas said, meaning that other factors must be contributing to the disparity.
"When we looked at the extent of coronary disease, we found there was little difference between blacks and whites," Thomas said. "However, when we looked at the incidence of procedures received by patients within 30 days of cardiac catheterization, we found that whites were 12 percent more likely to receive coronary bypass surgery."
According to Thomas, it is not clear why blacks did not receive coronary bypass surgery as often as whites. One possible explanation, he suggested, is that some physicians may have been biased against blacks, whether intentionally or not, as has been shown in past Duke studies. He also said that many blacks have a historical mistrust of the medical system, and so black patients might not have been as willing to undergo coronary bypass surgery, an invasive procedure.
"A big part of that mistrust is communication," Thomas said. "If black patients don't have a complete understanding of the procedure, or if it is not explained well, they may decline the procedure. If a physician or health care provider explains the procedure and what it entails, more black patients might agree to the surgery -- especially if the person doing the explaining were black or trained to be culturally sensitive."
Aside from less use of bypass surgery, other factors also likely contributed to the observed disparities and need to be investigated in future studies, Thomas said.
For example, he noted that heart patients typically receive optimal care while they remain in the hospital.
"However, when patients return to their home environment, they face many challenges and barriers to following their doctor's advice and maintaining a healthy lifestyle," he said. "Patients may not fill their prescriptions, or if they do, they may not take the medication over the long term. Often, patients may revert to bad habits in terms of diet and smoking. They may not return for follow-up doctor visits or they may not have doctors that they see regularly. These obstacles may disproportionately affect minority populations."
To learn more about what treatments work best for individual patients, Thomas said, the medical community should mount concerted efforts to attract more blacks into participating in clinical trials.
"There has been a history in the black community of mistrust of the health care system, which has often been seen as using blacks in medical experiments," Thomas said. "To overcome this mistrust, we must learn how to communicate in a culturally sensitive manner. Not all people are the same, so you have to tailor your communication to your patient if you want to improve outcomes."
He said the Association of Black Cardiologists, which is respected and trusted in the black community, is working in various ways to improve the levels of minority enrollment in clinical trials of heart therapies.
Also, he said he expects that results from the current Jackson Heart Study, a National Institute of Health supported study which is focusing on cardiovascular disease among the black residents in and around Jackson, Miss., will yield important data. This study, he said, may provide advances in the manner of the classic Framingham Heart Study, which began in 1948 and still continues, though it focuses primarily on white men.
Richard Merritt | EurekAlert!
Smart Data Transformation – Surfing the Big Wave
02.12.2016 | Fraunhofer-Institut für Angewandte Informationstechnik FIT
Climate change could outpace EPA Lake Champlain protections
18.11.2016 | University of Vermont
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water
In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...
The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.
Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
02.12.2016 | Medical Engineering
02.12.2016 | Agricultural and Forestry Science
02.12.2016 | Physics and Astronomy