• Posted November 30, 2022

Black Patients Fare Worse Than White Patients After Angioplasty, Stents

Black adults who undergo a common procedure to open up clogged arteries are readmitted to the hospital more often than their white peers. They're also more likely to die in the years after treatment, a new study finds.

Researchers looked at how patients fared following balloon angioplasty and coronary stenting -- "one of the most common cardiovascular procedures performed in the U.S.," said study co-author Dr. Devraj Sukul.

"We found significant differences in post-discharge outcomes such as readmission and long-term mortality," said Sukul, an interventional cardiologist at the University of Michigan.

The minimally invasive treatment is routinely offered to adults diagnosed with a narrowing of the coronary arteries. Doctors use a balloon to stretch open the artery, and often insert a short, wire mesh tube (stent) to keep the artery open.

Researchers analyzed data on 29,000 men and women in Michigan over age 65. They found that during the first 90 days post-procedure, Black patients were 62% more likely to be readmitted to a hospital. And over roughly four years, Black patients were 45% more likely to die than white patients.

In addition, three-quarters of white patients were referred for cardiac rehabilitation, compared with less than 60% of Black patients.

The results were published in the January 2023 issue of the American Heart Journal.

Delmonte Jefferson, executive director of the national nonprofit Center for Black Health & Equity, expressed little surprise at the findings.

"African American health and wellness is not valued in the U.S.," Jefferson said.

"Once we start to value optimal health for all," said Jefferson, "we'll see changes in our nation's infrastructure that will lead to greater access to care, and better mechanisms for prevention in order to reduce health disparities."

The study involved more than 26,000 white patients and about 3,000 Black patients. All underwent the artery-widening procedure between 2013 and 2018 at one of 48 Michigan-based hospitals.

Investigators found no large differences in post-procedure outcomes while patients were still in a hospital.

But after taking into account age and gender differences, they found a clear racial gap in the patient experience following discharge.

"There are many factors that likely explain this gap," said Sukul, pointing to stark differences in wealth, overall health status and access to health care. By each measure, Black patients, on average, were worse off than their white peers when they underwent stenting.

These factors are interconnected and accumulate over time, he added.

For example, Sukul noted, "Lower socioeconomic status can potentially lead to worse health status, just as illness may undermine financial security and economic opportunity."

As to what might help close the gap, the researchers called for better heart health care, both by reducing heart disease risks before procedures and by ratcheting up follow-up care.

More broadly, Sukul said "getting at the root cause of the structural barriers to health equity, such as access to high quality health care, economic mobility and adequate health insurance coverage, will remain critical.

"None of these are easy [fixes]," Sukul acknowledged, "but they are important."

More information

University of Chicago Medicine has more on racial disparities and heart health.

SOURCES: Devraj Sukul, MD, MSc. interventional cardiologist and clinical assistant professor, department of internal medicine, division of cardiovascular medicine, University of Michigan, Ann Arbor; Delmonte Jefferson, executive director, Center for Black Health & Equity, Durham, N.C.; American Heart Journal, January 2023