Black patients face higher risks following coronary artery bypass grafting

Despite advances in cardiovascular medicine, Black patients are 22% more likely than white patients to die in the hospital after coronary artery bypass grafting (CABG) surgery, according to a study of more than 1 million patients presented at the ANESTHESIOLOGY^® 2024 annual meeting.

Our large study shows that disparities in cardiovascular health care delivery in the U.S. are ongoing, especially in Black patients. We found Black patients who have coronary artery bypass surgery experience higher rates of severe postoperative complications, including death and cardiac arrest. These alarming statistics call for urgent action from governments and health care systems."

Vinicius Moreira, M.D., lead author of the study and chief anesthesiology resident at Advocate Illinois Masonic Medical Center, Chicago

In the study, researchers assessed a national inpatient database for patients undergoing CABG in the U.S. from 2016 to 2021. Among the 1,159,040 patients who had CABG during that time, 75.58% were white, 7.44% were Hispanic and 6.75% were Black (10.23% were categorized as belonging to other racial groups). Compared to white patients, Black and Hispanic patients were more likely to be younger. On average, white patients were 77 years old, Black patients were 63 years old and Hispanic patients were 64 years old. Black and Hispanic patients also were more likely to have heart failure: 10.6% for white patients, 12.2% for Hispanic patients and 15.4% for Black patients. 

Researchers determined that 2.4% of white, 2.5% of Hispanic and 3.2% of Black CABG patients died in the hospital. Compared to white patients:

• Black patients were 22% more likely to die in the hospital.
• Black patients stayed in the hospital 1.5 days longer on average (9.6 days for white patients, 10.7 days for Hispanic patients and 11.8 days for Black patients).
• Black patients had a 23% higher rate of cardiac arrest.
• Total hospital costs were $23,000 higher for Black patients and $78,000 higher for Hispanic patients.

Coronary arteries can be clogged due to plaque buildup, restricting blood flow to the heart and leading to chest pain, shortness of breath, and, in some cases, heart attack. CABG is a surgical procedure that takes a healthy blood vessel (usually from the leg, chest or arm) and attaches it to the aorta and the coronary artery just beyond the blockage so blood can flow to the heart.

"While advances in cardiovascular medicine, such as minimally invasive cardiac procedures and modern mechanical circulatory support devices, have increased life expectancy, our research suggests Black patients are less likely to have access to them. For example, we found that compared to white patients, a lower proportion of Black patients had bypass surgery when it was indicated," said Dr. Moreira. "It is imperative that modern policies focus on improving the screening, diagnosis and treatment of chronic conditions that disproportionately impact the Black population and other minorities. Although strides have been made in workforce diversity and addressing racial biases in health care technology, the path toward true equity remains long and requires a much more concerted effort."

He noted specific efforts that could reduce this disparity include:

• Anesthesiologists, surgeons and others who provide perioperative care should develop preventive measures to reduce the risk of complications for patients at higher risk.
• Preoperative and cardiovascular clinics should focus on rigorously optimizing patients' health conditions before surgery.
• Governments and health care systems must improve health care access and implement population-wide screening programs.
• Governments must implement robust policies for tackling the obesity epidemic, which disproportionately affects Black and Hispanic patients.