Study: Women, Lower-Income Patients Have Higher Rates of Death After Heart Surgery

New research has found that female patients have fewer heart surgeries, more urgent procedures, and higher mortality rates than men, whereas patients from lower-income neighborhoods have higher comorbidity burdens and receive less care at urban and academic medical centers.

These disparities remain despite advancements in techniques and treatments for patients with cardiovascular disease, as well as national and state-wide initiatives to help close disparity gaps, according to researchers at Brigham and Women’s Hospital. Researchers also found that women in the study had higher rates of urgent procedures and were in poorer health when they received surgery.

“Disparities in cardiac surgery are still with us, and they are larger than we thought they would be given everything we thought had been done to address them,” said lead author Paige Newell, MD, in a press release. “We were hoping to be able to report that disparities had improved, but our national study of 5 types of cardiac surgeries shows us that more needs to be done to close the disparity gap.”

They also found that patients residing in lower median household income quartile (MHIQ) neighborhoods had higher comorbidity burdens, higher proportions of urgent admissions, received less care at urban and academic hospitals, and had higher 30-day mortality rates.

As one of the largest national studies to date, investigators analyzed data from the Nationwide Readmissions Database for patients who underwent coronary artery bypass graft (CABG), surgical aortic valve replacement (SAVR), mitral valve replacement (MVR), mitral valve repair (MV repair), or ascending aorta surgery between 2016 and 2018. The sample included 358,762 patients.

Investigators found that fewer women underwent CABG (22.3%), SAVR (32.2%), MV repair (37.5%), and ascending aorta surgery (29.7%) compared to men and had higher 30-day mortality rates for each procedure. Patients in the lowest MHIQ also had higher 30-day mortality rates for these procedures compared to patients in the highest income quartile, according to the study.

“Cardiac surgery is primarily being performed on males, even though females are presenting with a higher comorbidity burden and frailty score,” Newell said in the press release. “The disparities in outcomes we are seeing may be due to under-diagnosis and under-treatment of cardiac disease in women.”

Although women made up the majority of patients undergoing mitral valve replacement, researchers note that further study is necessary to determine whether this is because of lower rates of repair, differences in pathology, lower rates of diagnosis, or delays in surgical treatment.

“Our study shows that disparities in outcomes are worst for females and low-income patients,” said corresponding author Tsuyoshi Kaneko, MD, in the press release. “We need to think about why and what we can do on a societal level. Right now, we are just tapping at the front door—there is a lot more that we need to understand about health equity and how sex, socioeconomic status, and patient outcomes are interlinked.”

REFERENCE

Women and Lower-Income Patients Have Higher Rates of Death After Heart Surgeries. News release; Brigham and Women’s Hospital. April 22, 2022. Accessed April 25, 2022. Email.