Race May Affect Use of Clot-Busters

by Associated Press

Doctors are more likely to give clot-busting drugs to whites than to blacks who have heart attacks, according to a study in today's New England Journal of Medicine.

The reasons are not clear but could include racial differences in heart attack symptoms, researchers at the University of Alabama at Birmingham said.

They found that women are as likely as men of the same race to get the drugs, which can clear blocked arteries quickly enough to prevent damage to the heart.

The study looked at the records of 26,575 Medicare patients who met strict standards for getting the drugs.

Overall, 57 percent of the patients got clot-busters. They were given to 59 percent of the white men, 56 percent of the white women, 50 percent of the black men and 44 percent of the black women. The differences between men and women of the same race disappeared once doctors took into consideration patients' age, medical history and other factors.

Doctors' decisions "as a result of clinical ambiguity, lack of adequate training, insufficient knowledge, or physicians' own preferences or biases" may have contributed to that difference, said Dr. John G. Canto, who led the study.

But, he noted, other studies have found that blacks are less likely than whites to have chest pain during heart attacks and lack of chest pain is a major reason not to give clot-busters.

In addition, there are racial differences in electrocardiograms, which are used to confirm that a heart attack has occurred.

"What is considered abnormal in whites can often be within the normal EKG reading range for blacks. Confirming that a heart attack has occurred may be more difficult in blacks than whites because it is harder to interpret the EKG findings," said Dr. Lynn Smaha, president of the American Heart Association.

Smaha said heart attack symptoms also are different in women and diabetics.

"The study highlights the importance of targeting our diagnostic tests to specific patient populations so that we are not missing opportunities to use these life-saving drugs," he said. This may mean that we need to find better tests for diagnosing heart disease, he said.