(Circulation. 2000;102:e9040.)
© 2000 American Heart Association, Inc.
Cardiovascular News |
Cardiovascular News
Poor Patients Survive Heart Surgery Less Often
Low-income and poorly educated patients are less likely to survive heart surgery than wealthier and better-educated patients, according to a study conducted by researchers at Duke University in Durham, NC. The researchers said that the patients in this group who do survive tend to have a lower quality of life.
In an article published in the November 6, 2000, issue of American Medical News, Chen Tung, MD, a Duke cardiologist and the study’s primary investigator, said that the patients in his study had other risk factors that tended to affect their survival. "They tend to be older. More of them tend to be female, and they also tend to be a sicker population. However, even after we adjusted for these differences, we still saw a difference in terms of both survival and quality of life," he said in a released statement.
Dr Tung said it was possible that wealthier, better-educated people may be more likely to change their diets and exercise habits to a lifestyle that promotes healthier hearts. In previous research, Dr Tung and his colleagues found that patients who had incomes <$10 000 per year also faced monthly medical expenses of $100 to $150, which came out-of-pocket because they were more likely to be uninsured or covered only by the limited Medicaid program. Twenty percent of these low-income patients either cut down or discontinued their prescribed medication because of the cost.
Patients with incomes >$20 000 were more likely to have medical insurance and, as a result, paid only $58 per month out-of-pocket for care they received after heart surgery. These kinds of disparities are what prompted Congress to direct the National Institutes of Health (NIH) to establish a center to study health disparities among the nation’s minorities.
"We have a moral obligation, a duty, and a responsibility to find effective ways to eliminate these disparities," said Representative John Lewis (D-Ga) in a report by the Associated Press. "Equal access to health care is not a privilege, it is a fundamental right."
The National Center on Minority Health and Health Disparities will coordinate minority health disparity research and information and identify areas where NIH studies into minority health problems are insufficient. The NIH already has a website dealing with the issue (http://healthdisparities.nih.gov/).
Older Surgeons’ Records for Endarterectomy Worse Than Those of Younger Surgeons
Surgeons who have performed endarterectomies for >20 years are more likely to have patients die than surgeons with fewer years in the operating room, according to a study performed by Liam O’Neill, MD, and colleagues at Cornell University in New York. Their study, which was published in the November issue of the journal Neurology, found that 1 of 100 patients who underwent the surgery performed by these older physicians died. This was the highest rate in the groups studied.
In their study, Dr O’Neill and his colleagues analyzed
information on nearly 13 000 operations performed by 532 surgeons over
a 2-year period in Pennsylvania. They found that neurosurgeons were the
least likely to have patients die, but once any surgeon had performed
the operation 
3 times in 2 years, that surgeon did not have a
greater-than-average risk of the patient dying. "However, time in
surgical practice was more important than surgical volume as a
predictor of patient outcome," the researchers wrote in their report.
Dr O’Neill and his colleagues theorized that older surgeons may not
keep up with the latest techniques and
improvements.
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