Psychology, 2010, 1, 229-232
doi:10.4236/psych.2010.14030 Published Online October 2010 (
Copyright © 2010 SciRes. PSYCH
The Impact of Sociodemographic Factors on
Knowledge of Cardiac Procedures
Samara Lipsky1, Michael Bohnen2, Janice Barnhart3
1Department of Psychology, Yeshiva University, Bronx, USA; 2Columbia University, New York, USA; 3Department of Epidemi-
ology and Population Health, Albert Einstein College of Medicine, Bronx, USA.
Received July 19th, 2010; revised July 26th, 2010; accepted August 3rd, 2010.
Background: This paper investigates the extent to which sociodemographic factors are associated with knowledge of
cardiac procedures in a sample of study participants treated for coronary heart disease (CHD). Research indicates the
importance of knowledge of CHD and its associated risks in order to prevent CHD. However, quantification of knowl-
edge levels among individuals undergoing cardiac procedures to treat CHD has not been well documented. Method:
Using a cross-sectional design, 156 participants, diverse in race/ethnicity, age, and sex, underwent elective cardiac
catheterization for the evaluation of chest pain and/or angina. Participants completed surveys regarding medical his-
tory, sociodemographic information, and knowledge of cardiac procedures. Ninety-five of these individuals, with clini-
cally significant CHD, were recommended by their physician to undergo a coronary revascularization procedure [per-
cutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG)]. These individuals
completed additional knowledge assessment surveys. Results: The overall knowledge scores for those undergoing
coronary angiography were suboptimal (M score = 4.6 out of 8). Older aged (> 65), male, married, white, col-
lege-educated participants demonstrated greater knowledge of cardiac catheterization procedures (all p values < 0.05).
Knowledge scores were greater among those revascularized than among participants undergoing coronary angiogra-
phy. Conclusions: Health professionals should provide general information about CHD treatment and interventions,
especially among women and ethnic minorities.
Keywords: Coronary Heart Disease, Knowledge, Cardiac Procedure
1. Introduction
Coronary heart disease (CHD) is the primary cause of
death for adults in the United States [1,2]. Numerous
reports outline disparities in knowledge of cardiovascular
disease among different sociodemographic groups for
individuals with CHD based on race/ethnicity and sex
[3,4]. For example, Woodard and colleagues (2005)
found that African Americans demonstrated less knowl-
edge regarding risk factors for cardiovascular disease,
compared to Caucasians. The lesser knowledge that Af-
rican Americans demonstrated regarding risk factors of
cardiovascular disease may directly correlate with the
finding that African American women with multiple car-
diac risk factors underestimated their risk for heart dis-
ease [5]. Furthermore, Mosca and colleagues (2000) sur-
veyed over 1,000 women and found that only 8% recog-
nized CHD or stroke as their greatest health concern and
less than one-third identified CHD as a leading cause of
death. Thus, lack of knowledge regarding personal risk
of CHD may impact decision-making regarding risk
prevention, and this impact may be heightened among
sociodemographic groups under-educated on the risks
and prevention of cardiovascular disease.
Few studies have examined the origin of the dispari-
ties in knowledge of CHD based on race/ ethnicity and
sex among individuals with CHD [3,4]. The root cause
might include the effect of a previously unmeasured
non-clinical factor: knowledge of the risks and benefits
of cardiac procedures, including coronary angiography
and revascularization (i.e. percutaneous transluminal
coronary angioplasty [PTCA] or coronary artery bypass
graft [CABG]) [3]. Determining if knowledge affects
individuals’ decision-making might aid in understand-
ing disparities in the provisions of the use of coronary
angiography or revascularization [6,7]. Moreover, if
knowledge levels of these cardiac procedures vary along
sociodemographic lines, the root of the disparity in know-
The Impact of Sociodemographic Factors on Knowledge of Cardiac Procedures
Copyright © 2010 SciRes. PSYCH
ledge of individuals with cardiovascular disease may be
targeted further.
2. Method
2.1. Participants
Individuals who met the following criteria were invited
to participate in the study: 1) 40 years of age; 2) un-
dergoing angiography for chest pain/pressure and/or an-
gina equivalents; and 3) able to give informed consent.
Out of 217 individuals eligible for the study, 181 agreed
to participate, and we obtained complete data from 156
participants. These 156 participants had their knowledge
level of the catheterization they were about to undergo
assessed. Ninety-five of these individuals had their
knowledge level of their subsequent revascularization
procedure assessed via bedside survey.
2.2. Procedure
Knowledge of cardiac procedures was investigated among
male and female participants scheduled for coronary an-
giography at an academic medical center in the Bronx.
These individuals were identified weekly using the logs at
this medical center. Trained interviewers abstracted infor-
mation from medical log books to locate eligible partici-
pants. Once located, individuals were asked to be inter-
viewed at bedside and permission was granted to access
their health information.
2.3. Measures
Following the baseline interview, medical record ab-
stractors used standardized forms to collect detailed in-
formation on medical history, angiography results, and
angina severity as classified by the Canadian Cardiovas-
cular Society [8]. These forms consisted of the following
items: age, race/ethnicity, sex, marital and employment
status, level of education, insurance, medical history,
angiography results, and treatment received. In addition,
all respondents completed eight true-false questions re-
garding knowledge of coronary angiography. One point
was assigned to each correct response (possible score 0
to 8). All individuals with clinically significant CHD that
underwent a revascularization procedure (i.e. PTCA or
CABG) also completed a survey pertaining to their re-
spective procedures. These surveys contained a mix of
true/false and multiple choice questions (possible scores
for CABG = 0 to 10; for PTCA = 0 to11). A higher mean
score indicated that the individual had greater knowledge
of his or her corresponding procedure.
2.4. Statistical Analysis
We used descriptive statistics (e.g. percentages, means,
standard deviations) to characterize the study population.
Univariate analyses allowed us to calculate the crude
rates for coronary angiography and revascularization (i.e.
PTCA and CABG) according to the patients’ demo-
graphic characteristics. We determined significant asso-
ciations with chi-square tests for categorical variables
(e.g. sex) and student’s t-tests for continuous variables
(e.g. age, knowledge scores). Marital status was coded as
married and not married (single, separated, divorced and
widowed). Age was dichotomized to 65 years and > 65
years based on the study population. Race/ethnicity was
coded as white and non-white (African American, His-
panic, Native American, Asian, and other). Level of edu-
cation was coded as college degree (college, graduate
school) and no college degree (high school, high school
diploma, some college experience but no degree obta-
ined). We calculated knowledge of cardiac procedures by
summing the number of correct responses to the an-
giography, PTCA, and CABG questions.
3. Results
3.1. Sociodemographic Characteristics
The study’s sample included 156 participants ranging in
age from 42 to 96 (mean = 69.2; SD = 9.5 years) and the
majority were women (93 females, 59.6% of partici-
pants). The major racial/ethnic groups were white (56%),
non-Hispanic black (18%), and Hispanic (16%). The
majority of participants had private insurance (60%) or
Medicare (20%). Most individuals had at least two risk
factors for CHD, hypertension and hypercholesterolemia
the most prevalent among them. Chronic stable angina
(moderate-severe) was the most common presenting
symptom. Fifty-eight percent of the participants had
mild-moderate CHD (i.e. at least 50% blockage of a main
heart artery) and PTCA was the more common revascu-
larization procedure performed (54%). Demographic
characteristics and clinical data of the study population
are displayed in Table 1.
3.2. Knowledge of Angiography
Knowledge levels of coronary angiography varied sig-
nificantly according to an individual’s sociodemographic
background. The overall mean score for the eight an-
giography knowledge questions was 4.6 (SD = 1.7) as
shown in Table 2. Scores ranged from 0 (n = 2) to 8 (n =
3). Participants who were over 65 years of age, male,
married, college educated, and white had higher mean
knowledge scores for cardiac catheterizations than their
respective counterparts (p < 0.05 for all comparisons).
Participants who were employed were more knowle-
dgeable about their procedures as well.
The Impact of Sociodemographic Factors on Knowledge of Cardiac Procedures
Copyright © 2010 SciRes. PSYCH
Table 1. Characteristics of Study Population (Total, n=154).
Variable Mean(±SD) Percentage
Age 69.2 (9.5)
Female 59.6
Married 62.2
Employed 42.3
Non-Hispanic Black
No college
Medicaid or Self-pay
Coronary Risk Factors
Two or more
Clinical Diagnosis
Atypical chest pain
Chronic stable angina Class I/II
Chronic stable angina Class III/IV
Unstable angina
Recent myocardial infarction
Angiography Results
Mild to moderate disease (1 or 2 vessels)
Severe disease (3 vessels or left main)
Treatment Received
1Other includes: 7Asians, 6 of unknown ethnicity or race, and 1 Native
2Other includes: 1 government (VA) and 2 SSI.
3.3. Knowledge of Revascularization Procedures
Ninety-five individuals were revascularized (CABG = 31;
PTCA = 64). Participants that underwent a CABG were
more knowledgeable regarding their procedure (mean
score = 8.0 out of 10, SD = 1.2) than those undergoing
PTCA (mean score = 7.9 out of 11, SD = 1.7). There were
Table 2. Knowledge of coronary angiography by select pa-
tient characteristics1 (Total, n=154).
Variable Mean (±SD)
Value p
65 years, (n=54)
>65 years, (n=100)
4.4 (1.7)
p = 0.018
Female, (n=60)
Male, (n=89)
3.9 (1.9)
5.1 (1.4)
p < 0.001
Yes, (n=94)
No, (n= 56)
4.9 (1.6)
4.2 (1.7)
p = 0.017
White, (n=84)
Non-white, (n=65)
4.9 (1.7)
4.2 (1.5)
p = 0.006
Yes, (n=64)
No, (n=85)
4.9 (1.5)
4.4 (1.7)
p = 0.052
College, (n=46)
No College, (n=102)
5.0 (1.6)
4.4 (1.6)
p = 0.031
1Mean correct score (total of eight questions). Overall mean score = 4.6( 1.7).
no significant demographic differences in knowledge
scores among the participants that underwent CABG.
However, married participants were more knowledge
about PTCA than those who were single (8.3[±1.5] vs.
7.3[± 1.8]; p = 0.026).
4. Discussion
General knowledge of coronary angiography was subop-
timal, while revascularized individuals were more
knowledgeable about their respective procedures (i.e.
CABG or PTCA). There were no race/ethnicity or sex
differences in knowledge or receipt of PTCA or CABG.
Furthermore, we found significant differences in knowl-
edge of coronary angiography according to age, sex,
race/ethnicity, marriage and level of education.
Our finding that men and participants who identified
themselves as white were overall more knowledgeable of
their procedures may follow a cause-and-effect relation-
ship, as men and whites undergo angiography more often
than women and ethnic minorities, respectively [9]. The
higher frequency by which males and white individuals
undergo coronary angiography compared to females and
ethnic minorities can in part be understood by noting that
African Americans have been found to be less willing
than white individuals to undergo these procedures [10].
This situation is not so clear-cut, though, as ethnic min-
rities may be offered coronary angiography less often,
and thus may not undergo these procedures at the same
The Impact of Sociodemographic Factors on Knowledge of Cardiac Procedures
Copyright © 2010 SciRes. PSYCH
high frequency. Nevertheless, a possible greater unwill-
ingness of African Americans to undergo coronary an-
giography compared to white individuals corresponds
with findings that African Americans are less likely than
white individuals to feel that their physicians have a par-
ticipatory style of decision making [11]. Whether African
Americans demonstrate low knowledge of coronary an-
giography due to a lack of trust in their physician is an
important consideration.
Most of our respondents were older individuals and
had multiple cardiovascular risk factors. Therefore, they
might have had a previous cardiac procedure. Moreover,
most of our study participants were referred by their pri-
mary care physicians or cardiologists for their cardiac
interventions. These two key characteristics of our study
participants suggest that knowledge among participants
may have varied depending on when in the course of
their disease they interacted with a physician or subspe-
cialist, or due to a systematic factor related to patient
communication. Alternatively, the lower education level
may have led to health illiteracy leading to lack of access
to or integration of available knowledge. These variables
warrant further study.
This study has limitations. We surveyed participants at
one academic institution, thus our results may have lim-
ited generalizability. We did not detect significant dif-
ferences in knowledge among the represented sociode-
mographic groups regarding CABG and PTCA. A larger
sample size may have shed light on this uncertainty.
While we only found significant sociodemographic
differences in levels of knowledge for coronary an-
giography and not for the revascularization procedures
(CABG and PCTA) surveys, it is important to consider
the nature of the questions we asked our study partici-
pants. While we tried to administer questions with a
similar range of difficulty in all surveys, we cannot be
fully confident that our questions offered a most precise
gauge of knowledge for each procedure.
5. Conclusions
In this study, sociodemographic variables appeared to be
associated with knowledge levels in individuals under-
going coronary angiography. These same variables did
not produce significant differences in knowledge levels
of individuals undergoing revascularization procedures.
Earlier findings that knowledge of cardiovascular disease
itself is low among under-educated sociodemographic
groups may support our finding that these groups demon-
strate low knowledge levels of related cardiac procedures.
Disparity in knowledge among individuals undergoing
coronary angiography warrants further study. Moreover,
empowering individuals with CHD with greater knowl-
edge of life-style or procedural treatments for CHD should
enhance health promotion, which may improve individu-
als’ quality of life before and after cardiac interventions.
Adequate access to and integration of available knowl-
edge becomes particularly important for individuals with
CHD who may benefit from more timely access to
medical care.
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