Disparities/Minority Health

Disparities persist in primary care referrals to cardiologists for cardiovascular disease

Women and patients at community health centers are less likely to have a cardiologist consultation than other outpatients with coronary artery disease (CAD) or congestive heart failure (CHF). Yet those who received consultations were more likely to reach target lipid or blood-sugar levels. Women in particular had more improvement than men when they received a cardiology consultation, according to a new study.

Researchers retrospectively examined electronic records of 9,761 adults with CAD or CHF at primary care practices affiliated with two academic medical centers from 2000 to 2005. During this 5-year period, 79.6 percent of patients with CAD and 90.3 percent of patients with CHF had a cardiology consultation. Women were 11 percent and 7 percent less likely than men to receive a consultation for CAD and CHF, respectively. In a similar fashion, patients at community health centers were 21 percent and 23 percent less likely than those at hospital-based practices to receive consultation for CAD and CHF, respectively.

Overall, quality of care for both CAD and CHF was suboptimal, with patients receiving 69.7 percent and 68.8 percent of applicable care, respectively, during the study period. Performance of care processes included lipid measurement, attainment of low-density lipoprotein (LDL) cholesterol of less than 130 mg/dL, blood-sugar control for diabetic patients, and recording patient weight. The first year mean performance score was 69.7 percent for those who consulted a cardiologist compared with 60.4 percent for those who didn't get a consult (year 3, 69.7 vs. 55.8 percent; year 7, 71.8 vs. 58.8 percent). Blacks were more likely to obtain an initial consultation, but blacks with CHF had fewer followup consultations than whites, which may reflect weaker relationships with their specialists. The study was supported by the Agency for Healthcare Research and Quality (T32 HS00020).

See "Differences in specialist consultations for cardiovascular disease by race, ethnicity, gender, insurance status, and site of primary care," by Nakela L. Cook, M.D., M.P.H., John Z. Ayanian, E. John Orav, and LeRoi S. Hicks, in the May 12, 2009, Circulation 119, pp. 2463-2470.

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