Blacks and Heart Bypass Surgery

A new study highlights the differences in the way black and white heart attack patients are treated in the U.S. Black patients, for example, are far less likely than whites to get specialized procedures like coronary bypass surgery. Cardiologist Dr. Gerald DeVaughn, president of the Association of Black Cardiologists, and his patient, Jean White, help us get to the heart of the matter.

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TONY COX, host:

And now an update on a story we told you about last week. According to a new study, there are major differences in the way black and white heart patients - heart attack patients are treated in the U.S. Black patients are far less likely than whites to get specialized procedures, like coronary bypass surgery. They're also more likely to die within a year. The complete findings appear in this month's Journal of the American Medical Association. To help us get to the heart of the matter, we're joined by cardiologist Dr. Gerald DeVaughn. He is president of the Association of Black Cardiologists.

Dr. DeVaughn, nice to have you on the show.

Dr. GERALD DeVAUGHN (President, Association of Black Cardiologists): Thanks for inviting me.

COX: I imagine as a cardiologist particularly as a black one that you are not surprised by these findings. Am I right?

Dr. DeVAUGHN: Not surprise at all. In fact, if you look at our organization, 33 years ago our founders of 17 cardiologists, black cardiologists got together at a national meeting and they compared notes. And they noticed that black patients were dying more frequently of cardiovascular disease, strokes, heart attacks, heart failure, and this issue was not being address by the scientific community.

So our organization was founded to promote awareness of cardiovascular disease in the African-American community and also to promote the science to see if we can understand why there is a disparity in the expression of this disease.

COX: There is the key word. Why is there a disparity? The study itself did not provide any of those answers. Can you?

Dr. DeVAUGHN: Well, the study didn't provide the answers, but the study documented there is a referral bias. That if you're an African-American and you present to a hospital with symptoms of a heart attack, it's less likely that you'll have potentially lifesaving procedures such as heart catheterization, angioplasty or a cardio-bypass surgery.

Now why? I think it's just about the cultural insensitivity of the providers of care. I'll give you an example. If you have a black woman from Mississippi who's rural, who's giving her story to a New England white male there is a possibility that there is a communication gap and just - it may be innocent. It maybe that that position is just not in tuned to the way this woman delivers her story and misses an opportunity to do something that would be in her best interest.

COX: Let's bring in a person who can talk about their own actual situation along those lines. Jean White(ph) is a patient of yours who had heart-bypass surgery in January. She lives in Pennsylvania. Mrs. White, nice to have you with us.

Ms. JEAN WHITE (Former Heart Surgery Patient, Pennsylvania): Hi. How are you today?

COX: Fine. Thank you. Tell us about your experience when you first went to the nurse practitioner, and briefly, did you feel that you were treated right?

Ms. WHITE: I'm not going to use the words treated right, I'm going to say that I don't believe that she gave me the attention, the medical attention that I deserved and that I needed. The symptoms that I was having - I was being treated for acid reflux. And actually I did not take the medication for that. I was told that you're having these symptoms because you're not taking your medicines - meaning, I'm not taking the acid reflux medicines.

And I said to her, I do not have acid reflux. I believe it's my heart. She says, no, I think you might just be depressed. And at that point, it was very frustrating for me and I literally cried because I felt that here is a woman who is not listening to my needs. And women find that - most women find that in the medical field that we are not heard. And it hurt the most when you're talking to another female and that person is not listening to you.

COX: Let me ask Dr. DeVaughn. How - I know this is only anecdotal but how common an experience do you think Jean White's experience was?

Dr. DeVAUGHN: It's not uncommon at all. Unfortunately, we are in a community where we see patients often, have been seen at other institutions and for - we can't understand why the diagnosis was not made elsewhere. In Mrs. White's case, she has two things going against her. She's female - we've demonstrated cardiovascular disparities in females - and she's African-American. And probably the group that is most vulnerable is an African-American female to being misdiagnosed.

COX: Now, what do we do about this? I suppose that would be the next step. How do you rectify what might be, according to your description and according to what the study says, is ingrained discriminatory approach to people coming in with heart disease?

Dr. DeVAUGHN: Well, a couple of things. I mean, shows like these and in the medical community, we have cultural sensitization programs where physicians might be made aware of the fact that they are missing that diagnosis. I believe, certainly a lot of these physicians are not racist. It's just innocence. It's just insensitivity to or lack of motivation in getting the information they need to treat patients well.

So the first thing I think we need is a lot of cultural sensitivity training so physicians can be made aware of the fact that there may be difference in the presentation of this disease in African-Americans. In addition to that we have a number of national guidelines that physicians should adhere to. And when you have an African-American patient, that patient should also be treated using those same guidelines and not some other metric for doing that.

COX: Let me bring Mrs. White back in. Really briefly, Mrs. White, did you sense that it was your race that was the primary driving factor in how this nurse was treating you?

Ms. WHITE: Well, I can't honestly say that it was my race because I had been there and I had seen her on other occasions. So I really can't say it was race in that particular case.

COX: All right. Are there, Dr. DeVaughn back to you, do you find - you mentioned - we've already talked about gender. Well, we talked about race as being factors that influence how medical practitioners treat certain people, are there other factors - regional for example or economic - that come into play here?

Dr. DeVAUGHN: Well, yeah. There are a lot of factors. One of the biggest factors is your insurability. If you don't have insurance, if you don't have the access to medical care, it is more likely that you won't get the care. One of the interesting things about this study is that they designed the study to compare apples to apples, black patients against white patients who have the same insurance, have the socio-economic status, have the same geographic status.

And even when you correct it for all of those things there is still was a referral bias. And that reason for the referral bias is something that we need more understanding for. It may be again, like I said an innocent way that the physicians are looking at patients, all the way down so there may actually be some racism there. So we have to have systems set in place so if you're African-American you will not get lesser care if you come to a hospital in America.

COX: Are you - I'm searching for the right word to ask you - are you confident, maybe that's too strong a word, are you hopeful that something can be done that will help change this, in the minute that we have left?

Dr. DeVAUGHN: I think so. One of the initiatives we have in the Association of Black Cardiologists is to educate more black physicians. Only two to three percent of the physicians in America are African-American. And I don't think that will, in itself, solve the problem but I think that if we put more African-American physicians into the system that itself will help desensitize the system so that African-Americans will be more likely to get the care that they need.

COX: Dr. DeVaughn, thank you very much for your insight.

Dr. DeVAUGHN: Thanks for having me.

COX: And Mrs. White, thank you as well.

Ms. WHITE: Thank you very much.

COX: Cardiologist Dr. Gerald DeVaughn is president of the Association of Black Cardiologists. He is also a clinical associate professor of medicine at Drexel University College of Medicine. He joined us from the studios of Audio Post in Philadelphia.

And we also heard from Jean White of Pennsylvania. She had heart-bypass surgery in January.

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