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Burton BN, Munir NA, Labastide AS, Sanchez RA, Gabriel RA. An Update on Racial Disparities With 30-Day Outcomes After Coronary Artery Bypass Graft Under the Affordable Care Act. J Cardiothorac Vasc Anesth 2019; 33:1890-1898. [DOI: 10.1053/j.jvca.2018.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Indexed: 11/11/2022]
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Angraal S, Khera R, Wang Y, Lu Y, Jean R, Dreyer RP, Geirsson A, Desai NR, Krumholz HM. Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999-2014. J Am Heart Assoc 2018; 7:e009014. [PMID: 30005557 PMCID: PMC6064835 DOI: 10.1161/jaha.118.009014] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/14/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND With over a decade of directed efforts to reduce sex and racial differences in coronary artery bypass grafting (CABG) utilization, and post-CABG outcomes, we sought to evaluate how the use of CABG and its outcomes have evolved in different sex and racial subgroups. METHODS AND RESULTS Using data on all fee-for-service Medicare beneficiaries undergoing CABG in the United States from 1999 to 2014, we examined differences by sex and race in calendar-year trends for CABG utilization and post-CABG outcomes (in-hospital, 30-day, and 1-year mortality and 30-day readmission). A total of 1 863 719 Medicare fee-for-service beneficiaries (33.6% women, 4.6% black) underwent CABG from 1999 to 2014, with a decrease from 611 to 245 CABG procedures per 100 000 person-years. Men compared with women and whites compared with blacks had higher CABG utilization, with declines in all subgroups. Higher post-CABG annual declines in mortality (95% confidence interval) were observed in women (in-hospital, -2.70% [-2.97, -2.44]; 30-day, -2.29% [-2.54, -2.04]; and 1-year mortality, -1.67% [-1.88, -1.46]) and blacks (in-hospital, -3.31% [-4.02, -2.60]; 30-day, -2.80% [-3.49, -2.12]; and 1-year mortality, -2.38% [-2.92, -1.84]), compared with men and whites, respectively. Mortality rates remained higher in women and blacks, but differences narrowed over time. Annual adjusted 30-day readmission rates remained unchanged for all patient groups. CONCLUSIONS Women and black patients had persistently higher CABG mortality than men and white patients, respectively, despite greater declines over the time period. These findings indicate progress, but also the need for further progress.
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Affiliation(s)
- Suveen Angraal
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Raymond Jean
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
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Alqahtani F, Aljohani S, Almustafa A, Alhijji M, Ali O, Holmes DR, Alkhouli M. Comparative outcomes of transcatheter aortic valve replacement in
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frican
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merican and
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aucasian patients with severe aortic stenosis. Catheter Cardiovasc Interv 2017; 91:932-937. [DOI: 10.1002/ccd.27257] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/06/2017] [Accepted: 07/29/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Fahad Alqahtani
- Division of CardiologyWest Virginia UniversityMorgantownWest Virginia
| | - Sami Aljohani
- Division of CardiologyWest Virginia UniversityMorgantownWest Virginia
| | - Ahmad Almustafa
- Division of CardiologyWest Virginia UniversityMorgantownWest Virginia
| | - Mohammed Alhijji
- Department of Cardiovascular DiseasesMayo ClinicRochester Minnesota
| | - Oluseun Ali
- Novant Health Heart & Vascular InstituteCharlotteNorth Carolina
| | - David R. Holmes
- Department of Cardiovascular DiseasesMayo ClinicRochester Minnesota
| | - Mohamad Alkhouli
- Division of CardiologyWest Virginia UniversityMorgantownWest Virginia
- Department of Cardiovascular DiseasesMayo ClinicRochester Minnesota
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The current state of ethnic and racial disparities in cardiovascular care: lessons from the past and opportunities for the future. Curr Cardiol Rep 2015; 16:530. [PMID: 25135343 DOI: 10.1007/s11886-014-0530-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Significant racial/ethnic disparities have been documented in cardiovascular care. Although health care quality is improving for many Americans, differences in clinical outcomes have persisted between racial/ethnic minority patients and non-minorities, even when income, education level, and site of care are taken into consideration. Potential causes of disparities are complex and are related to differences in risk factor prevalence and control, use of evidence-based procedures and medications, and social and environmental factors. Minority patients are more likely to receive care from lower-quality health care providers and institutions and experience more barriers to accessing care. Factors such as stereotyping and bias in medicine are hard to quantify, but likely contribute to differences in treatment. Recent trends suggest that some disparities are decreasing. Opportunities for change and improvement exist for patients, providers, and health care systems. Promising interventions, such as health policy changes, quality improvement programs, and culturally targeted community and clinic-based interventions offer hope that high-quality health care in the USA can be provided to all patients.
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Efird JT, O'Neal WT, Davies SW, O'Neal JB, Chitwood WR, Ferguson TB, Kypson AP. Operative status and survival after coronary artery bypass grafting. Heart Surg Forum 2015; 17:E82-90. [PMID: 24808447 DOI: 10.1532/hsf98.2013310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The effect of race on long-term survival of patients undergoing elective and nonelective coronary artery bypass grafting (CABG) is currently unknown. The purpose of this study was to compare long-term survival between black and white CABG patients by operative status. METHODS Long-term survival of black versus white patients undergoing elective and nonelective CABG procedures between 1992 and 2011 was compared. Survival probabilities were computed using the Kaplan-Meier product-limit method and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. RESULTS A total of 13,774 patients were included in this study. The median follow-up time for study participants was 8.2 years. Black patients undergoing elective CABG died sooner than whites (adjusted HR = 1.4, 95% CI = 1.2-1.5). Survival was similar between blacks and whites in the nonelective population (adjusted HR = 1.0, 95% CI = 0.96-1.1). CONCLUSIONS Black race was a statistically significant predictor of long-term survival after elective but not nonelective CABG.
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Affiliation(s)
- Jimmy T Efird
- East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Wesley T O'Neal
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Stephen W Davies
- Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Jason B O'Neal
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - W Randolph Chitwood
- East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC
| | - T Bruce Ferguson
- East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC
| | - Alan P Kypson
- East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC
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Pollock B, Hamman BL, Sass DM, da Graca B, Grayburn PA, Filardo G. Effect of gender and race on operative mortality after isolated coronary artery bypass grafting. Am J Cardiol 2015; 115:614-8. [PMID: 25596952 DOI: 10.1016/j.amjcard.2014.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/11/2014] [Accepted: 12/11/2014] [Indexed: 11/18/2022]
Abstract
Studies examining outcomes after coronary artery bypass grafting (CABG) by gender and/or race have shown conflicting results. It remains to be determined if, or how, gender and race are independent risk factors for CABG operative mortality. Using all consecutive patients who underwent isolated CABG at Baylor University Medical Center in Dallas, Texas, from January 2004 to October 2011, the risk-adjusted associations between gender and race, respectively, and operative mortality were estimated using a generalized propensity approach, accounting for recognized Society of Thoracic Surgeons risk factors for mortality. Women were nearly 2 times more likely to die during or within 30 days of the operation than men (odds ratio 1.96, 95% confidence interval 1.44 to 2.66, p <0.0001), while no significant mortality differences were observed among races. In conclusion, these findings suggest that women face a significantly greater risk for operative death that should be taken into account during the treatment decision-making process but that race is not associated with CABG mortality and so should not be among the factors considered.
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Affiliation(s)
- Benjamin Pollock
- Department of Epidemiology, Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas
| | - Baron L Hamman
- Department of Cardiothoracic Surgery, Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
| | - Danielle M Sass
- Department of Epidemiology, Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas
| | - Briget da Graca
- Department of Epidemiology, Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas
| | - Paul A Grayburn
- Department of Cardiology, Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
| | - Giovanni Filardo
- Department of Epidemiology, Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas.
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Efird JT, O'Neal WT, Griffin WF, Anderson EJ, Davies SW, Landrine H, O'Neal JB, Shiue KY, Kindell LC, Bruce Ferguson T, Randolph Chitwood W, Kypson AP. Increased coronary artery disease severity in black women undergoing coronary bypass surgery. Medicine (Baltimore) 2015; 94:e552. [PMID: 25700324 PMCID: PMC4554167 DOI: 10.1097/md.0000000000000552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Race and sex disparities are believed to play an important role in heart disease. The purpose of this study was to examine the association between race, sex, and number of diseased vessels at the time of coronary artery bypass grafting (CABG), and subsequent postoperative outcomes. The 13,774 patients undergoing first-time, isolated CABG between 1992 and 2011 were included. Trend in the number of diseased vessels between black and white patients, stratified by sex, were analyzed using a Cochran-Armitage trend test. Models were adjusted for age, procedural status (elective vs. nonelective), and payor type (private vs. nonprivate insurance). Black female CABG patients presented with an increasingly greater number of diseased vessels than white female CABG patients (adjusted P(trend) = 0.0021). A similar trend was not observed between black and white male CABG patients (adjusted P(trend) = 0.18). Black female CABG patients were also more likely to have longer intensive care unit and hospital lengths of stay than other race-sex groups.Our findings suggest that black female CABG patients have more advanced coronary artery disease than white female CABG patients. Further research is needed to determine the benefit of targeted preventive care and preoperative workup for this high-risk group.
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Affiliation(s)
- Jimmy T Efird
- From the Department of Cardiovascular Sciences (JTE, WFG, KYS, LCK, TBF, WRC, APK), East Carolina Heart Institute; Center for Health Disparities (JTE, HL), Brody School of Medicine, East Carolina University, Greenville; Department of Internal Medicine (WTO), Wake Forest School of Medicine, Winston-Salem; Department of Pharmacology and Toxicology (EJA), Brody School of Medicine, East Carolina University, Greenville, North Carolina; Department of General Surgery (SWD), University of Virginia School of Medicine, Charlottesville, Virginia; and Department of Anesthesia (JBO), Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Wang TK, Li AY, Ramanathan T, Stewart RA, Gamble G, White HD. Comparison of Four Risk Scores for Contemporary Isolated Coronary Artery Bypass Grafting. Heart Lung Circ 2014; 23:469-74. [DOI: 10.1016/j.hlc.2013.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/22/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
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He D, Mellor JM, Jankowitz E. Racial and ethnic disparities in the surgical treatment of acute myocardial infarction: the role of hospital and physician effects. Med Care Res Rev 2013; 70:287-309. [PMID: 23269575 DOI: 10.1177/1077558712468490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Many studies document disparities between Blacks and Whites in the treatment of acute myocardial infarction on controlling for patient demographic factors and comorbid conditions. Other studies provide evidence of disparities between Hispanics and Whites in cardiac care. Such disparities may be explained by differences in the hospitals where minority and nonminority patients obtain treatment and by differences in the traits of physicians who treat minority and nonminority patients. We used 1997-2005 Florida hospital inpatient discharge data to estimate models of cardiac catheterization, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting in Medicare fee-for-service patients 65 years and older. Controlling for hospital fixed effects does not explain Black-White disparities in cardiac treatment but largely explains Hispanic-White disparities. Controlling for physician fixed effects accounts for some extent of the racial disparities in treatment and entirely explains the ethnic disparities in treatment.
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Affiliation(s)
- Daifeng He
- College of William and Mary, Williamsburg, VA 23187-8785, USA
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Ethnicity and Race Variations in Receipt of Surgery among Veterans with and without Depression. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:370962. [PMID: 22013518 PMCID: PMC3195438 DOI: 10.1155/2011/370962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 07/19/2011] [Accepted: 07/31/2011] [Indexed: 11/18/2022]
Abstract
To examine equity in one aspect of care provision in the Veterans Health Administration, this study analyzed factors associated with receipt of coronary artery bypass graft (CABG), vascular, hip/knee, or digestive system surgeries during FY2006-2009. A random sample of patients (N = 317, 072) included 9% with depression, 17% African-American patients, 5% Hispanics, and 5% women. In the four-year followup, 18,334 patients (6%) experienced surgery: 3,109 hip/knee, 3,755 digestive, 1,899 CABG, and 11,330 vascular operations. Patients with preexisting depression were less likely to have surgery than nondepressed patients (4% versus 6%). In covariate-adjusted analyses, minority patients were slightly less likely to receive vascular operations compared to white patients (Hispanic OR = 0.88, P < .01; African-American OR = 0.93, P < .01) but more likely to undergo digestive system procedures. Some race-/ethnicity-related disparities of care for cardiovascular disease may persist for veterans using the VHA.
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