Black patients are 22% more likely than white patients to die in the hospital after coronary artery bypass grafting (CABG) surgery, analysis of more than 1 million patients treated in the USA has shown.
“Our large study shows that disparities in cardiovascular health care delivery in the USA are ongoing, especially in Black patients,” said Vinicius Moreira, lead author of the study (Advocate Illinois Masonic Medical Center, Chicago, USA), who presented the research at Anesthesiology 2024 (18–22 October, Philadelphia, USA), the annual meeting of the American Society of Anesthesiologists (ASA). “We found Black patients who have coronary artery bypass surgery experience higher rates of severe postoperative complications, including death and cardiac arrest. These alarming statistics call for urgent action from governments and health care systems.”
In the study, researchers assessed a national inpatient database for patients undergoing CABG in the USA from 2016 to 2021. Among the 1,159,040 patients who had CABG during that time, 75.58% were white, 7.44% were Hispanic and 6.75% were Black (10.23% were categorised as belonging to other racial groups).
Compared to white patients, Black and Hispanic patients were more likely to be younger. On average, white patients were 77 years old, Black patients were 63 years old and Hispanic patients were 64 years old. Black and Hispanic patients also were more likely to have heart failure: 10.6% for white patients, 12.2% for Hispanic patients and 15.4% for Black patients.
Researchers determined that 2.4% of white, 2.5% of Hispanic and 3.2% of Black CABG patients died in the hospital. Compared to white patients, Black patients were 22% more likely to die in the hospital, stayed in the hospital 1.5 days longer on average (9.6 days for white patients, 10.7 days for Hispanic patients and 11.8 days for Black patients), and had a 23% higher rate of cardiac arrest.
The researchers also found that total hospital costs were US$23,000 higher for Black patients and US$78,000 higher for Hispanic patients.
“While advances in cardiovascular medicine, such as minimally invasive cardiac procedures and modern mechanical circulatory support devices, have increased life expectancy, our research suggests Black patients are less likely to have access to them. For example, we found that compared to white patients, a lower proportion of Black patients had bypass surgery when it was indicated,” said Moreira. “It is imperative that modern policies focus on improving the screening, diagnosis and treatment of chronic conditions that disproportionately impact the Black population and other minorities. Although strides have been made in workforce diversity and addressing racial biases in health care technology, the path toward true equity remains long and requires a much more concerted effort.”
Specific efforts that could reduce this disparity, Moreira suggested, including anaesthesiologists, surgeons and others who provide perioperative care developing preventive measures to reduce the risk of complications for patients at higher risk. Preoperative and cardiovascular clinics should focus on rigorously optimising patients’ health conditions before surgery. Governments and health care systems must improve health care access and implement population-wide screening programmes. Governments must implement robust policies for tackling the obesity epidemic, which disproportionately affects Black and Hispanic patients.
