Racial and Ethnic Disparities in Perioperative Health Care Among Patients Undergoing Cardiac Surgery: JACC State-of-the-Art Review

Adam J Milam; Modele O Ogunniyi; Abimbola O Faloye; Luis R Castellanos; Ricardo E Verdiner; James W Stewart 2nd; Merije Chukumerije; Alexis K Okoh; Steven Bradley; Robert O Roswell; Paul L Douglass; Shakirat O Oyetunji; Alexander Iribarne; Debra Furr-Holden; Harish Ramakrishna; Sharonne N Hayes

doi:10.1016/j.jacc.2023.11.015

Racial and Ethnic Disparities in Perioperative Health Care Among Patients Undergoing Cardiac Surgery: JACC State-of-the-Art Review

J Am Coll Cardiol. 2024 Jan 30;83(4):530-545. doi: 10.1016/j.jacc.2023.11.015.

Authors

Adam J Milam¹, Modele O Ogunniyi², Abimbola O Faloye³, Luis R Castellanos⁴, Ricardo E Verdiner⁵, James W Stewart 2nd⁶, Merije Chukumerije⁷, Alexis K Okoh⁸, Steven Bradley⁹, Robert O Roswell¹⁰, Paul L Douglass¹¹, Shakirat O Oyetunji¹², Alexander Iribarne¹³, Debra Furr-Holden¹⁴, Harish Ramakrishna¹⁵, Sharonne N Hayes¹⁶

Affiliations

¹ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA. Electronic address: milam.adam@mayo.edu.
² Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Grady Health System, Atlanta, Georgia, USA.
³ Department of Anesthesiology, Emory University, Atlanta, Georgia, USA. Electronic address: https://twitter.com/bfaloyeMD.
⁴ Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego, La Jolla, California, USA. Electronic address: https://twitter.com/lrcastel.
⁵ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA. Electronic address: https://twitter.com/VerdinerMD.
⁶ Yale School of Medicine, Department of Surgery, New Haven, Connecticut, USA. Electronic address: https://twitter.com/stewartwjames.
⁷ Department of Cardiovascular Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA. Electronic address: https://twitter.com/DrMerije.
⁸ Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. Electronic address: https://twitter.com/OkohMD.
⁹ Department of Anesthesia and Critical Care, Moffitt Cancer Center, Tampa, Florida, USA. Electronic address: https://twitter.com/stevenbradleyMD.
¹⁰ Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell Health, New York, New York, USA. Electronic address: https://twitter.com/DrRobRoswell.
¹¹ Center for Cardiovascular Care, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA.
¹² Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington, USA. Electronic address: https://twitter.com/LaraOyetunji.
¹³ Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA.
¹⁴ Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA. Electronic address: https://twitter.com/DrDebFurrHolden.
¹⁵ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹⁶ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: https://twitter.com/SharonneHayes.

PMID: 38267114
DOI: 10.1016/j.jacc.2023.11.015

Abstract

There has been little progress in reducing health care disparities since the 2003 landmark Institute of Medicine's report Unequal Treatment. Despite the higher burden of cardiovascular disease in underrepresented racial and ethnic groups, they have less access to cardiologists and cardiothoracic surgeons, and have higher rates of morbidity and mortality with cardiac surgical interventions. This review summarizes existing literature and highlights disparities in cardiovascular perioperative health care. We propose actionable solutions utilizing multidisciplinary perspectives from cardiology, cardiac surgery, cardiothoracic anesthesiology, critical care, medical ethics, and health disparity experts. Applying a health equity lens to multipronged interventions is necessary to eliminate the disparities in perioperative health care among patients undergoing cardiac surgery.

Keywords: cardiac surgery; cardiovascular outcomes; disparities; ethnicity; health equity; race.

Publication types

Review

MeSH terms

Academies and Institutes
Anesthesiology*
Cardiac Surgical Procedures*
Cardiologists*
Health Equity*
Humans
United States / epidemiology