Women, blacks have higher CABG mortality rates
Women and black patients have higher coronary artery bypass grafting (CABG) mortality rates than men and white patients, according to research published in the Journal of the American Heart Association.
“Quality improvement initiatives for CABG have paralleled improved postoperative outcomes, despite declining CABG volumes in the United States,” wrote lead author Harlan M. Krumholz, of the Yale-New Haven Hospital in New Haven, Connecticut, and colleagues. “However, several studies have highlighted lower CABG utilization rates and worse post-CABG mortality among women and racial/ethnic minorities, particularly blacks. This awareness has spurred multifaceted local and national interventions aimed at narrowing sex- and race-related differences in CABG use and outcomes.”
The researchers sought to evaluate how CABG and its outcomes have evolved in different gender and racial subgroups.
Krumholz et al. examined Medicare data to determine gender- and race-based differences in CABG utilization, and post-CABG mortality and 30-day readmission rates over the past two decades in Medicare patients aged 65 and older. The researchers also evaluated trends in CABG utilization and early, and one-year postoperative outcomes after CABG among Medicare beneficiaries between 1999 and 2014.
More than 1.8 million Medicare beneficiaries, including 37 percent women and 5 percent blacks underwent CABG from 1999 to 2014. The researchers found:
- There was a total decrease from 611 to 245 CABG procedures per 100,000 person-years in all racial subgroups.
- Men compared with women and whites compared with blacks had higher CABG utilization, with declines in all subgroups.
- Women experienced a 66 percent decrease in CABG procedures, from 370 in 1999 to 127 in 2014.
- Men experienced a 60 percent decrease in CABG procedures, from 967 in 1999 to 392 in 2014.
- Blacks experienced a 51 percent decrease in CABG procedures, from 311 in 1999 to 151 in 2014.
- Whites experienced a 60 percent decrease in CABG procedures, from 650 in 1999 to 261 in 2014.
- There were declines in mortality rates in all subgroups—the overall in-hospital mortality rate declined by 37 percent in 1999 to 3 percent in 2014. Women and blacks experienced more incidences of mortality than men and whites.
- The 30-day mortality rate declined by 30 percent to 4 percent over the study period and showed a higher annual decline for women than men, and for black patients than white patients.
- For one-year mortality, women within a year of undergoing CABG faced higher rates than men in 2013 and in blacks compared with whites.
“Despite narrowing of the differences in post-CABG mortality over the study period, women and black patients continued to have worse outcomes,” Krumholz et al. wrote. “Furthermore, the burden of hospitalizations in the post-CABG period was high throughout the period, with one in five patients undergoing CABG readmitted within 30 days of discharge.
The researchers concluded their findings indicate there has been progress, though there could be more.
“Women and black patients had persistently higher CABG mortality than men and white patients, respectively, despite greater declines over the time period,” the authors concluded. “These findings indicate progress, but also the need for further progress.”
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.