Heart Care At High-Volume Hospitals May Matter More To African American Patients

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African American Heart Patients

African American patients who undergo heart bypass surgery in high-volume hospitals have more benefit than white patients.

According to a retrospective study, the number of heart bypass procedures a hospital performs appears to make more of a difference for African American patients than it does white patients.

"Hospitals that are doing more procedures are developing a higher level of expertise in all services," explains David Whellan, M.D., assistant professor of Medicine at Jefferson Medical College of Thomas Jefferson University. "This study shows that African American patients and those considered low risk receive the highest benefit by getting their heart care at a high-volume hospital."

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Lead researcher Dae Hyun Kim, M.D., MPH., a resident in the department of Medicine at Thomas Jefferson University Hospital, will present the results at the American Heart Association's Quality of Care and Outcomes Research Conference in Cardiovascular Disease and Stroke Conference in Washington, D.C. on May 10.

Previous research has shown that the greater number of heart bypass surgeries a hospital performs, the fewer hospital deaths result from these procedures. The Jefferson researchers set out to learn whether the volume-outcome relationship for a heart bypass procedure differs between white and black patients with different operative risks.

They used data provided by the University HealthSystem Consortium (UHC), an alliance of 97 academic medical centers and 149 of their affiliated hospitals representing nearly 90 percent of the nation's non-profit academic medical centers. The data for this study were culled from 93 medical centers that conducted almost 72,000 heart bypass procedures between 2002 and 2005.

In all, two percent of whites and 2.8 percent of blacks died in the hospital. There was a larger difference in the number of deaths between African American and white patients who were treated at the lowest-volume hospitals than in the remaining volume categories.

Yet by analyzing a number of measures, including race and operative risk, the researchers found that black patients have greater reduction in in-hospital mortality than whites by undergoing heart bypass procedures at high-volume hospitals.

To understand the reason behind the disparity, the researchers recommend that further studies be undertaken. "A goal is to help clinicians become more aware of potential biases," Dr. Whellan says.

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