Death and hospital readmission more likely for black patients after coronary stent placement

Death and hospital readmission more likely for black patients after coronary stent placement

Black patients who undergo minimally invasive procedures for clogged arteries are more likely to die or be readmitted to hospital months after the procedure, according to a Michigan Medicine study.

The research team analyzed more than 29,000 elderly patients with health insurance who underwent percutaneous coronary intervention, which includes stenting and balloon angioplasty, between 2013 and early 2018 at the using data from Michigan Cardiovascular Consortium Blue Cross Blue Shield. They found that black patients were 1.62 times more likely to be readmitted to hospital within 90 days of discharge from the intervention and were 1.45 times more likely to die at long follow-up. term taking into account age and sex.

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“We know that there are large racial disparities in cardiovascular disease, with black patients less likely to undergo coronary intervention or invasive angiography, but there is a lack of long-term outcome data for these patients after a coronary stenting procedure. said Stephanie Spehar, MD, first author of the study and chief medical resident of the Department of Internal Medicine at the University of Michigan.

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“We have seen nationwide efforts to improve the quality of coronary stenting care, particularly during the procedure, and current studies, including ours, show generally similar hospital outcomes for black and white patients” , Spehar said. “However, our results show a concerning disparity in outcomes after patients leave hospital.”

The results, published in the American Journal of the Heartreveal that the social determinants of health – including community economic well-being, personal income and wealth, and pre-existing health conditions – played an important role in the results.

“Our results demonstrate that these disparities can be, at least in part, explained by multiple complex factors, including the social determinants of health,” said the lead author. Devraj Sukul, MD, MSinterventional cardiologist at UM Health Frankel Cardiovascular Center and clinical assistant professor of cardiology at UM Medical School.

“Additionally, it is extremely important to focus on understanding and potentially resolving these disparities in peri-procedural and post-procedural contexts,” Sukul said. “All of these factors, such as wealth, community economic stress and comorbidities, are interconnected and accumulate over time. Lower socioeconomic status can potentially lead to poorer health, just as illness can undermine financial security and economic opportunity. Preventative measures must be taken to address the complex social, environmental and behavioral factors that contribute to these outcomes.

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Percutaneous coronary intervention is performed both for patients with emergency situations, such as a heart attack, as well as for those with exertional chest pressure or chest discomfort. It is one of the most common cardiovascular procedures performed in the United States, with more than 635,000 procedures performed in 2017.

In addition to the long-term disparities found 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 these disparities at discharge 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 hypertension and diabetes, in minority groups,” Spehar said. “Clinicians can also partner with social services to address issues such as transportation and copayments, trying to remove financial barriers to care. And cardiovascular care providers must prioritize ongoing cultural competence and training on implicit biases.

Other authors include Milan Seth, MS, Peter Henke, MD, John Syrjamaki, MPH, Hitinder Gurm, MD, all of Michigan Medicine, Khaldoon Alaswad, MD, David Nerenz, Ph.D., both of Henry Ford Health System , Theodore Schreiber, MD Ascension Macomb-Oakland Hospital, Aaron Berman, MD, Beaumont Hospital, Omar E. Ali, MD, Detroit Medical Center Heart Hospital, Yousef Bader, MD, McLaren Bay Regional Heart and Vascular.

Funding/Disclosures: Support for BMC2 is provided by Blue Cross and Blue Shield of Michigan and Blue Care Network through the BCBSM Value Partnerships program. Although Blue Cross Blue Shield of Michigan and BMC2 work cooperatively, the opinions, beliefs and views expressed by the author do not necessarily reflect the opinions, beliefs and views of BCBSM or any of its employees.

Article quoted: Race and Outcomes After Percutaneous Coronary Intervention: Insights from the Michigan Blue Cross Blue Shield Cardiovascular Consortium“, American Journal of the Heart. DOI: 0.1016/j.ahj.2022.10.001

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