Background Epidemiologic studies have reported differences in the use of cardiovascular procedures according to the race and sex of the patient. Whether the differences stem from differences in the recommendations of physicians remains uncertain. Methods We developed a computerized survey instrument to assess physicians' recommendations for managing chest pain. Actors portrayed patients with particular characteristics in scripted interviews about their symptoms. A total of 720 physicians at two national meetings of organizations of primary care physicians participated in the survey. Each physician viewed a recorded interview and was given other data about a hypothetical patient. He or she then made recommendations about that patient's care. We used multivariate logistic-regression analysis to assess the effects of the race and sex of the patients on treatment recommendations, while controlling for the physicians' assessment of the probability of coronary artery disease as well as for the age of the patient, the level of coronary risk, the type of chest pain, and the results of an exercise stress test. Results The physicians' mean (±SD) estimates of the probability of coronary artery disease were lower for women (probability, 64.1±19.3 percent, vs. 69.2±18.2 percent for men; P<0.001), younger patients (63.8±19.5 percent for patients who were 55 years old, vs. 69.5±17.9 percent for patients who were 70 years old; P<0.001), and patients with nonanginal pain (58.3±19.0 percent, vs. 64.4±18.3 percent for patients with possible angina and 77.1±14.0 percent for those with definite angina; P<0.001). Logistic-regression analysis indicated that women (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) and blacks (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) were less likely to be referred for cardiac catheterization than men and whites, respectively. Analysis of race–sex interactions showed that black women were significantly less likely to be referred for catheterization than white men (odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.7; P=0.004). Conclusions Our findings suggest that the race and sex of a patient independently influence how physicians manage chest pain.

The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization

Racialized science seeks to explain human population differences in health, intelligence, education, and wealth as the consequence of immutable, biologically based differences between "racial" groups. Recent advances in the sequencing of the human genome and in an understanding of biological correlates of behavior have fueled racialized science, despite evidence that racial groups are not genetically discrete, reliably measured, or scientifically meaningful. Yet even these counterarguments often fail to take into account the origin and history of the idea of race. This article reviews the origins of the concept of race, placing the contemporary discussion of racial differences in an anthropological and historical context.

/pdf/race-as-biology-is-fiction-racism-as-a-social-problem-is-25dlybdszx.pdf

Race as biology is fiction, racism as a social problem is real: Anthropological and historical perspectives on the social construction of race.

When race matters.

Committee on understanding and eliminating racial and ethnic disparities in health care

The authors’ review of the health services literature since the release of the landmark Report of the Secretary’s Task Force Report of Black and Minority Health in 1985 revealed significant differences in access to medical care by race and ethnicity within certain disease categories and types of health services. The differences are not explained by such factors as socioeconomic status (SES), insurance coverage, stage or severity of disease, comorbidities, type and availability of health care services, and patient preferences. Under certain circumstances when important variables are controlled, racial and ethnic disparities in access are reduced and may disappear. Nonetheless, the literature shows that racial and ethnic disparities persist in significant measure for several disease categories and service types. The complex challenge facing current and future researchers is to understand the basis for such disparities and to determine why disparities are apparent in some but not other disease categories and service types.

Racial and Ethnic Differences in Access to Medical Care

Underuse of Coronary Revascularization Procedures: Application of a Clinical Method

Aims This study sought to evaluate the feasibility of a rapid deflation technique (RDT) after transradial catheterisation to achieve patent haemostasis and to assess whether this could reduce radial artery occlusion (RAO). Ensuring patent haemostasis is the most important factor in reducing RAO. The use of larger sheath sizes and antiplatelet and antithrombotic agents limits achieving patent haemostasis immediately after transradial intervention. Methods and results A feasibility assessment was first performed in 105 patients to assess whether RDT could be performed safely and consistently achieve patent haemostasis after transradial catheterisation. Prospective data were then collected on 201 patients who underwent either rapid or standard deflation technique and had RAO assessment at 24 hours. Acute coronary syndrome was the indication for transradial catheterisation in 62.7% of patients. Baseline patent haemostasis increased from 40% to 95% after RDT. RAO at 24 hours was seen in two (2.0%) patients in the RDT group and 15 (14.9%) in the standard deflation group (OR 0.117; 95% CI: 0.026 to 0.526, p=0.005). Other independent predictors of RAO included body surface area (OR 0.022; 95% CI: 0.002 to 0.273, p=0.003) and male sex (OR 0.298; 95% CI: 0.108 to 0.824, p=0.020). No significant difference was found in safety outcomes: need to re-inflate compression band (2% versus 1.8%) or haematoma (0% versus 0.9%). Conclusions Rapid deflation of the compression band after transradial catheterisation is a safe and effective method of achieving patent haemostasis that reduces RAO.

/pdf/facilitated-patent-haemostasis-after-transradial-423943c27w.pdf

Facilitated patent haemostasis after transradial catheterisation to reduce radial artery occlusion.

Chagas disease (CD), with associated conduction abnormalities, is a common indication for pacemaker implantation in Latin America. The prevalence of CD in Latin American immigrants with pacemakers residing in the United States has never been studied. This single-center cross-sectional study included pacemaker patients who were aged 18 years or more with a previous residence in Latin America for at least 6 months. Patients with an implantable cardioverter-defibrillator, cardiac resynchronization therapy, or iatrogenic and/or congenital heart block were excluded. Serological testing for Trypanosoma cruzi was performed at enrollment. A total of 80 patients were enrolled, and CD was diagnosed in six patients (7.5%). Patients with CD were more likely to be from El Salvador (P = 0.001). Other clinical, therapeutic, electrocardiographic, and echocardiographic variables were similar between the CD and non-CD groups. There is a high prevalence of CD among Latin American immigrants with pacemakers in Los Angeles.

/pdf/the-prevalence-of-chagas-disease-among-latin-american-12eembyfr3.pdf

The Prevalence of Chagas Disease Among Latin American Immigrants with Pacemakers in Los Angeles, California.

Background: Sinus node dysfunction, atrioventricular (AV) block and atrial fibrillation (AF) are associated with advanced age. Required therapy commonly includes pacemaker implantation. 

Methods: We report the course of therapy for an 87-year-old with symptomatic sinus node dysfunction and paroxysmal atrial fibrillation who was intolerant of drug therapy.

Results: The patient received a pacemaker for treatment of sick sinus syndrome. She continued to have symptomatic episodes of AF and was intolerant of pharmacologic therapy despite adequate rate support provided by the pacemaker. The AF suppression algorithm in the pacemaker was enabled, resulting in the elimination all AF episodes effectively eliminating the need for antiarrhythmic medication. If this continues to stabilize her atrium, withdrawal of anticoagulation therapy is anticipated. 

Conclusions: The clinical presentation of sinus node dysfunction and related conduction abnormalities is common in the elderly. Pharmacologic management is often a challenge in the presence of the advanced age and concomitant disease processes. In individuals who have paroxysmal atrial fibrillation or are likely to develop this and who need a pacemaker for standard indications, the availability of an AF Suppression™ algorithm may facilitate their management without needed to use medications or being able to utilize lower doses of those medications.

Pacing for the suppression of paroxysmal atrial fibrillation in an 87-year-old patient.

Underuse of Coronary Revascularization Procedures

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Robin Wachsner

Author Tools

Chat about Author