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Race may predict poor outcomes after CABG
Black race was an independent predictor of elevated morbidity and mortality after CABG, even after adjustment for patient, clinician, hospital and care factors, according to new findings.
Although previous research has shown that black patients had worse outcomes than whites after CABG, even after adjustment for patient factors, it was not known if the difference would persist after adjustment for clinician, hospital and care factors, according to the study background.
Researchers analyzed black (n = 11,697) and white (n = 136,362) patients who underwent isolated CABG between 2010 and June 2011 at one of 663 sites participating in the Society of Thoracic Surgery database.
Rajendra H. Mehta, MD, MS, and colleagues evaluated procedural outcomes and adjusted for patient clinical features, patient socioeconomic features, hospital effects, surgeon effects and care processes such as use of internal mammary artery grafts and perioperative medications.
Compared with whites, blacks were more likely to be younger, female and have a higher BMI. In addition, they were more likely to have a history of hypertension, diabetes, smoking, peripheral disease, cerebrovascular disease, immunosuppressive medications, preoperative dialysis, and to be treated at hospitals with higher risk-adjusted mortality, the researchers wrote.
After adjustment for patient characteristics, income and hospital/surgeon, blacks were less likely to receive all four National Quality Forum-endorsed perioperative medications (OR = 0.897; 95% CI, 0.84-0.95) and more likely to not have the internal mammary artery used (OR = 1.265; 95% CI, 1.16-1.38) than whites, Mehta and colleagues found.
Unadjusted mortality rates were higher in blacks than in whites (2.8% vs. 2%; P < .0001), as were unadjusted morbidity rates (19.4% vs. 13.6%; P < .0001), they found.
After adjustment for patient characteristics, income, hospital, surgeon, use of internal mammary artery and use of perioperative medications, black race remained an independent predictor of operative mortality (HR = 1.17; 95% CI, 1-1.36) and major morbidity (HR = 1.26; 95% CI, 1.19-1.34), according to the researchers.
“Our study demonstrated that these previous racial differences in CABG outcomes still existed on a national scale in contemporary clinical practice,” they wrote. “Our data also suggested that the reasons for these differences may be complex and multifactorial.”
In a related editorial, Keith B. Churchwell, MD, FAHA, wrote that “overall, it is a troubling assessment that bears the need for a deeper dive into the medical, economic, social and societal barriers that has led to a difference in outcomes.”
Churchwell, from the Heart and Vascular Center at Yale-New Haven Hospital, wrote that the medical community should set three goals to narrow the gap: to better understand patients’ lives, even if it means going to them; implementing best practice standards to improve outcomes at worse-performing hospitals; and to advance the science and care continuum with programs such as the American Heart Association’s Strategically Focused Research Network. – by Erik Swain
Disclosure: The researchers and Churchwell report no relevant financial disclosures.