Takakuwa Kevin M, Shofer Frances S, Limkakeng Alexander T, Hollander Judd E
Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA 19107-5004, USA.
Am J Emerg Med. 2008 Jun;26(5):545-50. doi: 10.1016/j.ajem.2007.08.020.
There are known race and sex differences in emergent cardiac care. Many feel these differences reflect a bias from the physician. We hypothesized these differences may be the result of patient preferences.
Emergency department (ED) patients 40 years and older with a chief complaint of chest pain were surveyed from July 11 through December 9, 2005, at 2 academic EDs. This prospective survey study included demographics and prior cardiac test experience. Preferences for hypothetical cardiac tests and procedures were compared between race and sex using chi(2) or Fisher exact tests.
Two hundred sixteen patients were enrolled. The mean age was 55 +/- 12 years (43% men and 51% black). Blacks compared with whites preferred the electrocardiogram (ECG) to the technetium-99m sestamibi (MIBI) stress test. Blacks also preferred a percutaneous coronary intervention (PCI) compared with whites who were more likely to forego PCI. These racial differences disappeared when a physician recommended a procedure. There were no race preferences between PCI vs coronary artery bypass graft, whether or not a doctor recommended the procedure. For sex, there were no preferences between ECG vs MIBI stress test or cardiac catheterization, whether or not a doctor recommended the test or procedure. With regard to a choice between PCI and coronary artery bypass graft, women were more likely to decline the procedure than men. Even with a physician-recommended procedure, women were more likely to refuse than men, whereas men were more likely to accept it.
Blacks were more likely to prefer the less invasive stress test and wanted PCIs more, but these racial differences disappeared when a physician-recommended test was offered. Women were more likely to refuse the most invasive cardiac procedure compared with men. The sex-related preferences might partially explain why women receive fewer invasive cardiac procedures than men. However, race-related cardiac preferences suggest that other factors beyond patient preference account for fewer PCIs in black patients.
已知在紧急心脏护理方面存在种族和性别差异。许多人认为这些差异反映了医生的偏见。我们推测这些差异可能是患者偏好的结果。
2005年7月11日至12月9日，在两家学术性急诊科对40岁及以上以胸痛为主诉的急诊科（ED）患者进行了调查。这项前瞻性调查研究包括人口统计学和既往心脏检查经历。使用卡方检验或Fisher精确检验比较种族和性别之间对假设的心脏检查和治疗的偏好。
共纳入216例患者。平均年龄为55±12岁（43%为男性，51%为黑人）。与白人相比，黑人更喜欢心电图（ECG）而非锝-99m甲氧基异丁基异腈（MIBI）负荷试验。与更倾向于放弃经皮冠状动脉介入治疗（PCI）的白人相比，黑人也更喜欢PCI。当医生推荐某种治疗时，这些种族差异消失。无论医生是否推荐，PCI与冠状动脉旁路移植术之间没有种族偏好。对于性别，无论医生是否推荐检查或治疗，ECG与MIBI负荷试验或心导管检查之间没有偏好。关于PCI和冠状动脉旁路移植术之间的选择，女性比男性更有可能拒绝该治疗。即使是医生推荐的治疗，女性也比男性更有可能拒绝，而男性更有可能接受。
黑人更倾向于选择侵入性较小的负荷试验，并且更希望进行PCI，但当提供医生推荐的检查时，这些种族差异消失。与男性相比，女性更有可能拒绝最具侵入性的心脏治疗。与性别相关的偏好可能部分解释了为什么女性接受的侵入性心脏治疗比男性少。然而，与种族相关的心脏偏好表明，除患者偏好外的其他因素导致黑人患者接受的PCI较少。
