A Michigan Medicine study found that black patients who undergo minimally invasive procedures for blocked arteries are more likely to die or be readmitted to the hospital months after the procedure.
The research team analyzed more than 29,000 elderly patients with Medicare insurance who underwent percutaneous coronary intervention, which includes stenting and balloon angioplasty, between 2013 and early 2018 using data from Blue Cross Blue Shield from the Michigan Cardiovascular Association. They found that black patients were 1.62 times more likely to be readmitted to hospital within 90 days of discharge from the operation, and 1.45 times more likely to die at long-term follow-up when adjusting for age and sex.
“We know that wide racial disparities exist in cardiovascular disease, that black patients are less likely to undergo coronary intervention or invasive angiography, but there is a lack of data on long-term outcomes for these patients after coronary stenting,” said Stephanie Spahar, PhD. in Medicine, the study’s first author and chief resident in the University of Michigan’s Department of Internal Medicine.
“We’ve seen efforts nationwide to improve the quality of coronary stent care, particularly during the procedure, and existing studies including ours show generally similar outcomes within the hospital for black and white patients,” Spehar said. “However, our findings show an alarming disparity in outcomes after patients leave the hospital.”
Results, Posted in American Heart Journalrevealing that the social determinants of health—including a community’s economic well-being, personal income and wealth, and pre-existing health conditions—played an important role in the findings.
“Our findings show that these differences may be, at least in part, explained by multiple complex factors including social determinants of health,” said the senior author. Devraj Sokol, MD, MAFrankel, an interventional cardiologist at the UM Health Frankel Cardiovascular Center and clinical assistant professor of cardiology at the UM School of Medicine.
“Moreover, a focus on understanding and potentially addressing these disparities in both semi-procedural and post-procedural settings is critical,” said Sokol. All of these factors, such as wealth, societal economic pressures, and co-morbidities, are interrelated and add up over time. Low socioeconomic status can lead to poor health, just as illness can undermine financial security and economic opportunity. Preventive action must be taken to address the complex social, environmental and behavioral factors that contribute to these outcomes.”
Percutaneous coronary intervention is performed for patients coming in for emergency situations, such as a heart attack, as well as those who suffer from chest pressure with exertion or chest discomfort. It is one of the most common cardiovascular procedures performed in the United States Completed more than 635,000 procedures in 2017.
In addition to the long-term disparities revealed in the study, 75% of white patients were referred for cardiac rehabilitation, compared to 58.5% of black patients. The researchers say the findings highlight the need to reduce such disparities in discharge time after PCI, which will require a multifaceted effort.
“We need policies to strengthen and expand programs that have been developed to reduce the burden of cardiovascular disease, such as high blood pressure and diabetes, in minority groups,” Spehar said. “Physicians can also partner with social services to address issues such as transportation and shared costs, in an effort to remove financial barriers to care. Cardiovascular providers must prioritize ongoing cultural competence and tacit training over bias.”
Additional authors include Milan Seth, MA, Peter Henke, MD, John Sierjammaki, MPH, Hetender Gorm, MD, both from Michigan Medicine, Khaldun Al Aswad, MD, and David Nirens, PhD, both from Henry Ford Health System , Theodore Schreiber, MD, Ascension Macomb-Oakland Hospital, Aaron Berman, MD, Beaumont Hospital, MD, Omar E. Ali, MD, Detroit Medical Center, Yusef Bader Heart Hospital, MD, McLaren Bay Regional Heart and Vascular.
Funding/Disclosures: Support for BMC2 is provided by Blue Cross, Blue Shield of Michigan and the Blue Care Network as part of the BCBSM Value Partnerships program. Although Blue Cross Blue Shield of Michigan and BMC2 work collaboratively, the opinions, beliefs, and viewpoints expressed by the author do not necessarily reflect the views, beliefs, and viewpoints of BCBSM or any of its employees.
Paper cited: “Race and outcome after percutaneous coronary intervention: insights from the Michigan Blue Cross Blue Shield Cardiovascular Federation“,” American Heart Journal. doi: 0.1016/j.ahj.2022.10.001
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