Homelessness and Race are Mortality Predictors in US Veterans Undergoing CABG

Chandra, Ramesh; Meier, Jennie; Khoury, Mitri K.; Weisberg, Asher; Nguyen, Yen Thi Hai; Peltz, Matthias; Jessen, Michael E.; Heid, Christopher A.

doi:10.1053/j.semtcvs.2022.10.001

Cited by 5 publications

(4 citation statements)

References 35 publications

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“…Though the finding that people experiencing homelessness account for so large a share of Los Angeles' methamphetamine-related deaths is novel, it squares with previous studies of homelessness, mortality, and methamphetamine use. Homelessness is a known risk for premature mortality from a variety of specific causes, including overdose, cardiovascular disease, and infectious diseases (Brown et al, 2022;Chandra et al, 2022;Chang et al, 2022;Nicholas, Greenwell, Henwood, & Simon, 2021). Previous studies in Los Angeles have documented an association between homelessness and recent methamphetamine use (Anderson-Carpenter, Fletcher, Swendeman, & Reback, 2019), including among youth, where peer group methamphetamine use has been shown to be especially salient (Barman-Adhikari, Begun, Rice, Yoshioka-Maxwell, & Perez-Portillo, 2016;Zhao, Kim, Li, Hsiao, & Rice, 2018).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Changes in Co-Involved Drugs, Comorbidities, and Demographics of Methamphetamine-Related Deaths in Los Angeles County

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Longitudinal Changes in Co-Involved Drugs, Comorbidities, and Demographics of Methamphetamine-Related Deaths in Los Angeles County

et al. 2022

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“…Despite a similar predominance of White men in the enrollment of landmark heart failure trials, equivalent GDMT efficacy in women and men has been shown through meta-analysis [72] . Underprescription of GDMT remains an issue, but there may be no significant racial disparity in prescription patterns; in fact, Black patients are more likely to achieve the target dose due to baseline hypertension [73,74] . Patients with poor LVEF recovery are followed closely for chronic issues of cardiorenal syndrome, congestive hepatopathy, pulmonary hypertension, and evaluation of candidacy for advanced heart failure therapies.…”

Section: Operative Managementmentioning

confidence: 99%

Disparities in therapies for coronary artery disease with reduced left ventricular ejection fraction

Ghunaim,

Vervoort,

Elfaki

et al. 2023

Vessel Plus

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Revascularization through percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is used to manage left ventricular systolic dysfunction (LVSD) due to coronary artery disease (CAD). This review provides an overview of coronary revascularization for CAD with reduced left ventricular ejection fraction (LVEF), focusing on disparities in management. CABG provides more complete revascularization, and lower long-term all-cause mortality and reintervention and MI rates compared to PCI in patients with LVSD and CAD. Consequently, CABG is recommended as the primary revascularization therapy for CAD with reduced LVEF, with PCI being reserved for patients who are high-risk or have unfavorable coronary anatomy. Although LVSD increases revascularization risk, differential outcomes can be attributed to patients’ biological, behavioral, and socioeconomic factors as well as health system deficiencies. Women and racially and/or ethnically minoritized patients often present with progressive disease and greater comorbidity, experience delays in diagnosis and treatment, and have higher morbidity and mortality rates post-revascularization. These disparities may be explained by biological differences compounded by social determinants of health. Patients with CAD with LVSD pose unique medical challenges, which may be further complicated by disparities in care. Increased representation of minoritized patients in cardiovascular trials is needed to elucidate these differences and their long-term impact.

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“…Looking at postoperative surgical outcomes in PEH, Niu et al, 16 in their small cohort study of patients undergoing arthroplasy, found no increased risk of readmission, revision, or joint infection. However, on a much larger analysis of outcomes of coronary artery bypass surgery in U.S. veterans, Chandra et al 17 found homelessness to be an independent predictor of 30-day mortality. Within Australia, de Jager et al, 18 in their recent retrospective data review of surgical outcomes, identified a higher risk of postoperative mortality and surgical complication for unemployed and low socioeconomic background patients.…”

Section: Introductionmentioning

confidence: 99%

“…Clearly, homelessness carries significant risks to health care, and recent research indicates it is a predictor for poor outcomes of surgery in certain cohorts. 17 Intuitively, it is assumed that homelessness impairs the recovery of the surgical patient, but the scale of the detriment has not been established across a broader surgical cohort.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Homelessness, Substance Use, and Mental Illness on Surgical Inpatient Outcomes in Australia

Warburton,

Rush,

Cullen

et al. 2023

Asia Pac J Public Health

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This study investigates inpatient surgical outcomes for people experiencing homelessness (PEH) in Australia. Retrospective administrative health data of emergency surgical admissions from a single center over 5 years, 2015 to 2020, was included. Independent associations between factors and outcomes were analyzed with binary logistic and log-linear regression. Of 11 229 admissions, 2% were experiencing homelessness. People experiencing homelessness were on average younger (49 vs 56 years), more likely to be male (77% vs 61%), suffer mental illness (10% vs 2%), and substance use disorders (54% vs 10%). People experiencing homelessness were not more likely to suffer surgical complications. However, male sex, older age, mental illness, and substance use were risk factors for poor surgical outcomes. Homelessness predicted greater odds of discharge against medical advice (4.3 times) and longer length of stay (1.25 times). These results highlight the need for health interventions simultaneously addressing physical, mental health, and substance use issues in the care of PEH.

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Homelessness and Race are Mortality Predictors in US Veterans Undergoing CABG

Cited by 5 publications

References 35 publications

Longitudinal Changes in Co-Involved Drugs, Comorbidities, and Demographics of Methamphetamine-Related Deaths in Los Angeles County

Longitudinal Changes in Co-Involved Drugs, Comorbidities, and Demographics of Methamphetamine-Related Deaths in Los Angeles County

Disparities in therapies for coronary artery disease with reduced left ventricular ejection fraction

The Impact of Homelessness, Substance Use, and Mental Illness on Surgical Inpatient Outcomes in Australia

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