In a study, published online in the American Journal of Cardiology, Drs. Michael Yeung (Division of Cardiology, University of North Carolina, Chapel Hill, USA) and Alan Zajarias (Division of Cardiology, Washington University School of Medicine, St. Louis, USA) noted that although prior studies have shown that Black patients undergo interventions for acute myocardial infarction less frequently than do white patients, the role of race in aortic valve replacement had not been previously investigated. Accordingly, the Washington University School of Medicine investigators conducted a study to determine (1) if African Americans with severe aortic stenosis underwent aortic valve replacement less frequently than Caucasians with severe aortic stenosis and (2) to identify the possible reasons for any disparity that was present.
Using data from patients cared for at Barnes-Jewish Hospital, the investigators identified patients with severe aortic stenosis. Of 880 patients who were identified with severe aortic stenosis and known treatment status, 791 (90%) were Caucasian and 89 were African American (10%). Although the rates of symptomatic aortic stenosis were similar between racial groups, Caucasians complained more frequently of dyspnea and African Americans had evidence of worse disease severity on echocardiogram. Overall, 51% of patients with severe aortic stenosis underwent aortic valve replacement. However, significantly fewer African Americans underwent surgery than Caucasians (39% vs. 53%, respectively; p=0.019). The reasons for not undergoing surgery (ranging from advanced age to lack of symptoms) were mostly similar between groups, but African Americans more frequently declined aortic valve surgery than did Caucasians. Zajarias and colleagues reported that previous studies have suggested that cultural preferences influence the decision-making process in cardiac surgery, and that cultural preferences may explain why more African Americans declined surgery in their retrospective study. Zajarias told Cardiovascular News: “Socioeconomic status may influence the ability of patients to fully understand a disease process, treatment options and their implications. This may be one of the reasons leading to the treatment differences seen in the previous studies.”