Functional status outcomes among white and African-American cardiac patients in an equal access system

Background: Racial disparities exist in invasive cardiac procedure use and, sometimes, in subsequent functional status outcomes. We explored whether racial differences in functional outcomes occur in settings where differences in access and treatment are minimized. Methods: We conducted a prospective observational cohort study of 1022 white and African-American cardiac patients with positive nuclear imaging studies in 5 VA hospitals. Patients' functional status was assessed at baseline, 6, and 12 months later using the Seattle Angina Questionnaire and the SF-12, controlling for treatment received, clinical, sociodemographic, and psychological characteristics. Results: There were no significant baseline effects of race on functional status, after adjusting for sociodemographics, comorbid conditions, maximal medical therapy, severity of ischemia on nuclear imaging study, personal attitudes, and beliefs. Although there were no race differences in percutaneous transluminal coronary angioplasty use, there was a trend of African Americans being less likely to undergo coronary artery bypass graft, after 6 months (1.4% vs 6.5%) and 1 year (1.9 vs 6.9%). After adjustment, the decline in the SF12 Physical Component Summary from baseline to 6 months was, on average, 2.4 points less for African Americans than for whites, and at 12 months, Anginal Stability improved 8.4 points more for African Americans. The relative strength and direction of both findings persisted after removing covariates that might be confounded with race, and African Americans decreased less than whites on Physical Limitations, and improved more on Treatment Satisfaction, Anginal Frequency, and Disease Perceptions. Conclusions: In a setting where differences in access are minimized, so are racial differences in functional status outcomes.