Blacks less likely to undergo heart bypass surgery
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Black patients who are hospitalized after a heart attack are less likely than their white counterparts to undergo coronary bypass surgery, also referred to as revascularization, regardless of whether or not the hospital has a service specializing in this surgery, new research shows.
A number of studies have documented racial differences in coronary revascularization rates. However, few studies have looked at the impact that a hospital revascularization service may have on this difference.
Dr. Ioana Popescu, from The University of Iowa Hospitals and Clinics in Iowa City, and colleagues analyzed data for over 1.2 million Medicare beneficiaries to determine whether a hospital revascularization service affected the rates of revascularization by race. A total of 4,627 US hospitals with or without this service were included in the analysis.
The findings appear in the Journal of the American Medical Association.
Thirty-one percent of white patients admitted to a hospital without revascularization services were transferred to a hospital that did have this service compared with 25.2 percent of black patients, a statistically significant difference.
For white patients, the revascularization rate when they were admitted to centers with revascularization services was 50.2 percent, and 25.9 percent when they were admitted to one without these services. The corresponding 1-year mortality rates were 30.2 percent and 37.6 percent.
For black patients, the revascularization rates were significantly lower compared with whites—34.3 percent for those admitted to centers with revascularization services and 18.3 percent for those admitted to centers lacking such services. The corresponding mortality rates were also higher among black patients—35.3 percent and 39.7 percent.
Further analysis of the data indicated that mortality during the first 30 days after admission was actually lower for black patients than for white patients, but beyond this period it was consistently higher among blacks.
As more information on the benefits of revascularization in different patient subgroups becomes available, efforts to standardize the treatment protocols for heart attack patients and to aggressively treat patient risk factors are important to eliminate these racial differences in patient care, the authors conclude.
SOURCE: Journal of the American Medical Association, June 13, 2007.
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