March 11, 1994
Media Contact: Joann Rodgers
Phone: (410) 955-8659
Some studies report that women and minority patients with heart disease are less likely to undergo sophisticated heart tests, suggesting that there could be some degree of discrimination in the care of these patients. But a new Johns Hopkins study says that educational achievement of patients may have a greater influence on the care patients get than gender, race or any other demographic factor.
"Our results show that patients with less than a high school education were two and a half times more likely to disagree with or refuse their doctor's recommendation for cardiac catheterization,"says Daniel E. Ford, M.D., M.P.H., lead author of the Hopkins study, which is scheduled for presentation at the American College of Cardiology's 43rd Annual Scientific Session. The patients were interviewed at the time of their admission to the coronary care unit.
This study shows that as we continue to study the use of medical services like catheterization, we need to pay special attention to patient preferences and how we communicate to our patients," says Ford.
Catheterization, the use of dye injected into arteries to view the cardiovascular MI system, is a necessary first step to diagnosis and treatment.
"We need catheterization to determine if angioplasty or even bypass surgery is needed to help patients with heart disease," says Pascal Goldschmidt, M.D., a cardiologist and co-author of the study. "This report suggests to us that we need to be especially vigilant in how we communicate options and alternatives to patients' with lower levels of education. We need to take the time to be certain that all patients are able to make informed decisions about their care."
The researchers interviewed 272 patients just after they were admitted to two different coronary care units -- one at Johns Hopkins, the other at its affiliate, The Francis Scott Key Medical Center. The patients were asked to use a five-point scale (1 -agree, 5 - disagree), to rate their level of agreement with a recommendation for cardiac catheterization. Patients with more than a high school education had a mean score of 2.0, while those with less than a high school education (56 percent) had a mean score of 2.47, Fifty-eight percent of those interviewed were male, 25 percent were AfricanAmerican and 44 percent had a family income between $10,000 and $30,000. Cardiac critical care nurses were responsible for the patients' interviews, under the direction of Alison Schecter, who was a medical resident at Johns Hopkins. The study was supported by the Henry Ciccarone Center for the prevention of heart disease at Johns Hopkins.