African-American Heart Patients Have Poorer Quality Of Life

ATLANTA - Duke University Medical Center researchers have demonstrated for the first time that African-American heart patients tend to suffer worse symptoms and be more functionally impaired as a result of their heart disease

The new finding is important because it builds on previous studies demonstrating that African-Americans appear less likely to receive procedures to re-establish blood supply to ailing hearts and that they have higher mortality rates.

Using a standardized test that measures how disease affects everyday living, the Duke researchers found a significant difference between the scores reported by African-Americans compared to white heart patients, above and beyond what would be expected given the known disparities in care and outcome. African-Americans also reported higher levels of chest pain (angina).

While the researchers cannot explain why this racial disparity exists, they emphasize that their findings should open up a new area for aggressive research activity.

Although we knew there are racial disparities in care, we did not know how these differences affected patients' symptoms and functional status," said Padma Kaul, Ph.D., a postdoctoral fellow at the Duke Clinical Research Institute. "This is the first time racial differences in symptoms and quality of life has been quantified."

The results of the Duke team's analysis were prepared for presentation today (March 19) at the 51st annual scientific sessions of the American College of Cardiology.

For the study, the researchers tested 1,392 (1,150 white, 242 African-American) patients who were diagnosed with coronary artery disease after a cardiac catheterization at Duke University Hospital between August 1998 and April 2001.

At enrollment, patients took a standardized test known as the SF-36, a questionnaire describing such factors as perceptions of general health, mental health and social functioning. It also measures how patients feel their illness has impacted their everyday mental and physical activities. The test has been used for years for different diseases and is considered a reliable measure of patients' perceptions of their quality of life. Final results are based on a 100-point scale.

Patients also took the Seattle Angina Questionnaire, a standard test that gauges patients' perceptions of the severity of their angina. Patients retook both tests six months later.

At cardiac catheterization, African-Americans had lower functional status scores and similar symptoms as whites. In this study population, 60 percent of the African-Americans received an angioplasty or bypass surgery, compared to 72 percent for whites, a statistically significant disparity. By six months, function outcomes in both cohorts improved, however, African-Americans continued to report worse functional status and angina symptoms compared to whites. These differences persisted even after adjusting for baseline characteristics and revascularization status.

Said Duke cardiologist Eric Peterson, M.D., "While there have been past studies looking at the differences in health care delivery between African-Americans and whites, this is the first to actually measure how having heart disease impacts on everyday life."

Peterson is senior member of the research team who has published widely on the issue of racial disparities in health care.

"The fact that African-Americans report that their symptoms and functional outcomes are worse is a very important finding," he continued. "What is more difficult is understanding exactly why. But this is a very important issue that definitely needs to be addressed to ensure that all patients benefit from treatments."

There are some hypotheses that might explain the disparities, Peterson said, but so far, nothing has been proven. It might be, Peterson said, that the natural course of heart disease might be different in African-Americans than whites or their response to therapy.

He also said it was possible that African-Americans and whites might have differing perceptions of their own health and personal situations. Even though the team measured these items at baseline and at six months, cultural differences still could explain some of the difference in perceptions.

Other potential factors include those that occur once patients leave the hospital, such as compliance with prescriptions given at discharge, and whether or not patients adjust their lifestyles in response to their heart disease. For Kaul, these findings should influence the design of future cardiology studies.

"In the past, the primary measurement or endpoint has been death or heart attack, but with the advances in medicine there are fewer and fewer of these events," she said. "We should be looking at improving quality of life and functional status, and if we find that African-Americans do worse because of medical practice patterns, we need to educate providers about all the treatment options."

Kaul's analysis was supported by the Duke Clinical Research Institute. Barbara Lytle of Duke was also part of the research team.

Note to editors: Dr. Padma Kaul can be reached at (919) 668-8592 or kaul0002@mc.duke.edu. Dr. Eric Peterson can be reached at (919) 668-8830 or peter018@mc.duke.edu.