A new study is as stark reminder for cardiac surgeons worldwide: prioritising equal access to life-saving surgery is essential.
New research recently highlighted alarming disparities in access to heart surgery for women, Black individuals and those from low-income households in England.
Published in the journal Heart, the study reveals that these groups are significantly less likely to receive cardiac surgery compared to men, white individuals and those from affluent backgrounds.
Those who do undergo heart surgery face a higher risk of dying within a year, underscoring urgent calls for action to address these inequities.
Cardiac surgery, including coronary artery bypass grafting (CABG) and heart valve procedures, is a crucial but costly treatment for cardiovascular disease, with approximately 28,000 adults in the UK undergoing such procedures annually.
Previous research has shown that short-term outcomes can be influenced by gender, ethnicity and socioeconomic status. However, this new study aimed to examine the long-term impact of these factors.
Researchers analysed Hospital Episode Statistics (HES) and Office for National Statistics (ONS) data on patients admitted with heart disease in England between 2010 and 2019.
They focused on death rates both in-hospital and within one, three, and five years after surgery, as well as rates of hospital readmission due to cardiovascular issues, heart failure, or stroke.
The study included 292,140 patients who underwent cardiac surgery during the 10-year period. It found stark disparities in access to surgery:
• Women were 59% less likely to undergo CABG and 31% less likely to have valve surgery compared to men.
• Black patients were 32% less likely to receive CABG and 33% less likely to have valve surgery compared to white patients.
• Socioeconomic disadvantage also played a role, with the most deprived individuals being 35% less likely to receive CABG and 39% less likely to have valve surgery than the least deprived.
These disparities extended to outcomes. Despite a 20% reduction in hospital deaths during the study period, women, Black patients, and those from deprived backgrounds were more likely to die within a year of surgery.
For instance, women were 24% more likely to die within a year following CABG, and Black patients faced an 85% higher mortality risk compared to white individuals.
The authors acknowledge that limitations in hospital coding and unrecorded ethnicity data for 10% of patients may have affected the results.
However, the findings align with broader trends observed in Europe and the US, indicating a decline in cardiac surgery usage and similar inequalities in care.
The researchers urge healthcare systems worldwide to prioritise these disparities.
‘There is an urgent need to address inequalities through enhanced data linkage, transparency, and improved benchmarking on inequality characteristics,’ the authors conclude.
In a linked editorial, Dr Dominique Vervoort from the University of Toronto emphasises the need for high-income countries to evaluate their assumptions about equal access to care critically.
‘Health systems must identify and address gaps in care caused by social determinants of health, to ensure no patient is left behind,’ he writes.
