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Black heart patients found to get key surgery less


Raising troubling questions about health care for blacks, researchers report today that blacks are significantly more likely to suffer and die from sudden heart failure than whites, and that whites with heart disease are far more likely to undergo surgery to correct it than blacks.

The findings, published in separate articles in the New England Journal of Medicine, highlight striking racial differences that, in the case of the second study, cannot be attributed to socioeconomic factors, such as the ability to pay.

One explanation, experts say, is that prejudice influences physicians' judgment, preventing white doctors from recommending certain procedures to black patients, or patients from accepting them. Only 3 percent of the nation's doctors are black.

"We are dependent on the majority of the population for health services," said Dr. Edward S. Cooper, a prominent black physician and past president of the American Heart Association.

The studies send an important message to the nation's health care reformers that financial barriers are not the sole reason some Americans do not receive quality medical care.

Each of the studies published today breaks new ground. The first, conducted by researchers at the University of Chicago, offers the first large-scale comparison of cardiac arrest among blacks and whites. It found that blacks were twice as likely as whites to suffer cardiac arrest, and more than three times as likely to die of it.

The second, and in some ways more disturbing, study was a nationwide examination of nearly 430,000 Veterans Administration hospital patients with heart disease. The study was undertaken by the University of Pittsburgh Medical Center and the Pittsburgh Veteran Affairs Medical Center.

It found that even when finances are not a consideration, whites were two and three times as likely as blacks to undergo surgical procedures.

The findings add to a well-documented body of research that shows blacks in the United States die of cardiovascular disease faster than whites. Scientists do not fully understand the reasons for this and are investigating biological causes.

In the Chicago study, Dr. Lance Becker and his colleagues in the emergency department of the University of Chicago Medical Center analyzed every cardiac arrest that occurred in their city over a two-year period, 6,451 cases in all.

Sudden cardiac arrest accounts for about 300,000 deaths each year -- nearly 15 percent of all deaths in America. The Chicago researchers found that, black or white, chances of survival were dim; only 3 percent of whites survived, and 1 percent of blacks. The low survival rates for both groups, experts said, are typical of large urban areas, where paramedics often cannot respond quickly to emergencies.

Yet at each link in the so-called "chain of survival," the researchers found, blacks were less likely to survive than whites.

The Pittsburgh study was the first to examine treatment of heart disease among blacks and whites who had equal access to medical care and ability to pay for it.

The study looked at three surgical procedures: cardiac catheterization, in which a fine tube is inserted into the heart to investigate its condition; angioplasty, in which a balloon is introduced to constricted blood vessels in an attempt to widen them and clear blockages; and coronary artery bypass surgery, in which doctors reroute blood past blocked arteries.

The researchers found that, while 19.3 percent of whites underwent catheterization, only 11.8 percent of blacks did.

Angioplasty was performed on 1.8 percent of whites and 0.8 percent of blacks; and though 5 percent of all whites had bypass surgery, only 1.6 percent of blacks did.

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