Race and Ethnicity in Cardiac Surgery: A Missed Opportunity?

Elfaki, Lina A.; Nwakoby, Akachukwu; Keshishi, Melanie; Vervoort, Dominique; Yanagawa, Bobby; Fremes, Stephen E.

doi:10.1016/j.athoracsur.2023.10.025

Cited by 2 publications

(1 citation statement)

References 52 publications

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“…The influence of social determinants of health (e.g., gender, ethnicity and deprivation) on mid and long-outcomes of cardiac surgery have not been explored. It is known that women and people from ethnic minorities and of low socio-economic status have worse short term outcomes after all types of cardiac surgery (in-hospital), [3][4][5][6][7] but it is unclear whether these characteristics also translate to poorer mid (one year) and long-term outcomes (three and five years respectively).…”

Section: Introductionmentioning

confidence: 99%

Inequalities in access to and outcomes of cardiac surgery in England: retrospective analysis of Hospital Episode Statistics (2010-2019)

Lai,

Gibbison,

O’Cathain

et al. 2024

Preprint

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ObjectivesTo characterise the variation in access to and outcomes of cardiac surgery for people in England.MethodsWe included people >18 years of age with a hospital admission for ischaemic heart disease (IHD) and heart valve disease (HVD) between 2010 and 2019. Within these populations, we identified patients who had coronary artery bypass graft (CABG) and/or valve surgery, respectively. We fitted logistic regression models to examine the effects of age, sex, ethnicity and socio-economic deprivation on having access to surgery and in-hospital mortality, 1-year mortality and hospital readmission.ResultsWe included 292,140 people, of whom 28% were women, 11% were from an ethnic minority and 17% were from the most deprived areas. Across all types of surgery, 1 in 5 patients are readmitted to hospital within 1 year, rising to almost 1 in 4 for valve surgery patients. Women, Black people and people living in the most deprived areas were less likely to have access to surgery (CABG: 59%, 32%, 35% less likely; valve: 31%, 33%, 39% less likely, respectively) and more likely to die within 1 year of surgery (CABG: 24%, 85%, 18% more likely, respectively; valve: 19% (women) and 10% (people from most deprived areas) more likely).ConclusionFemale sex, Black ethnicity, and economic deprivation are independently associated with limited access to cardiac surgery and higher post-surgery mortality. Actions are required to address these inequalities.WHAT IS ALREADY KNOWN ON THIS TOPICThere has been a marked improvement in short term (in hospital) outcomes of people having cardiac surgery. It is not clear if this translates to improvement in mid- and long-term outcomes and how these differ by demographic and socio-economic factors.WHAT THIS STUDY ADDSAcross all types of cardiac surgery, 1 in 5 patients are readmitted to hospital within 1 year of surgery, rising to almost 1 in 4 for valve surgery patients.While in hospital mortality has decreased markedly since 2010 (by 20%), 1 year mortality and hospital readmission remained largely unchanged.Women, people of Black ethnicity and people from the most socially deprived areas were less likely to be offered cardiac surgery and more likely to die and be readmitted to hospital in the year after surgery.HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYTargeted interventions are required across the cardiovascular medicine pathway to improve mid- and long-term outcome in patients having cardiac surgery, addressing inequalities.

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Section: Introductionmentioning

confidence: 99%

Inequalities in access to and outcomes of cardiac surgery in England: retrospective analysis of Hospital Episode Statistics (2010-2019)

Lai,

Gibbison,

O’Cathain

et al. 2024

Preprint

View full text Add to dashboard Cite

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Racial and Ethnic Disparities in Peri-and Post-operative Cardiac Surgery

Scott,

Gouchoe,

Azap

et al. 2024

Curr Cardiovasc Risk Rep

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Purpose of Review Despite efforts to curtail its impact on medical care, race remains a powerful risk factor for morbidity and mortality following cardiac surgery. While patients from racial and ethnic minority groups are underrepresented in cardiac surgery, they experience a disproportionally elevated number of adverse outcomes following various cardiac surgical procedures. This review provides a summary of existing literature highlighting disparities in coronary artery bypass surgery, valvular surgery, cardiac transplantation, and mechanical circulatory support. Recent Findings Unfortunately, specific causes of these disparities can be difficult to identify, even in large, multicenter studies, due to the complex relationship between race and post-operative outcomes. Current data suggest that these racial/ethnic disparities can be attributed to a combination of patient, socioeconomic, and hospital setting characteristics. Summary Proposed solutions to combat the mechanisms underlying the observed disparate outcomes require deployment of a multidisciplinary team of cardiologists, anesthesiologists, cardiac surgeons, and experts in health care equity and medical ethics. Successful identification of at-risk populations and the implementation of preventive measures are necessary first steps towards dismantling racial/ethnic differences in cardiac surgery outcomes.

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Race and Ethnicity in Cardiac Surgery: A Missed Opportunity?

Cited by 2 publications

References 52 publications

Inequalities in access to and outcomes of cardiac surgery in England: retrospective analysis of Hospital Episode Statistics (2010-2019)

Inequalities in access to and outcomes of cardiac surgery in England: retrospective analysis of Hospital Episode Statistics (2010-2019)

Racial and Ethnic Disparities in Peri-and Post-operative Cardiac Surgery

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