Women over 65 who need complex heart surgery are more likely than men to be treated at hospitals with lower quality, which leads to higher death rates for these women, according to a study by Michigan Medicine.
The study, published in JAMA Network Open, examined almost 450,000 Medicare patients who had coronary artery bypass grafting (CABG), also known as heart bypass surgery, from late 2015 to early 2020.
This surgery is done to improve blood flow to the heart by bypassing blocked arteries. It is a common procedure for treating severe heart disease.
The researchers found that women were 1.26 times more likely than men to have their surgery at low-quality hospitals, defined as those with the highest rates of death within 30 days after the procedure.
At these low-quality hospitals, 7% of women died after surgery compared to nearly 5% of men. The difference in death rates between men and women doubled when comparing high-quality to low-quality hospitals.
Dr. Catherine M. Wagner, the lead author of the study and a surgery resident at the University of Michigan, stated, “Women are more likely to die after heart bypass surgery and more likely to have the surgery at low-quality hospitals.
We need to improve these hospitals and ensure women are referred to better hospitals to reduce this gap.”
The study also found that women often had unplanned admissions before their heart bypass surgery and had more existing health conditions than men.
Previous studies have shown that women with heart disease are referred for surgery later than men. This delay in treatment may be due to biological differences between men and women that have not been well-studied.
Hospitals that perform more heart bypass surgeries each year tend to have better outcomes for patients, especially those with moderate to high-risk conditions.
Dr. Andrew Ibrahim, a co-author of the study and associate professor of surgery at the University of Michigan, explained, “The differences in outcomes we see are likely due to both patient risk and the quality of care at each hospital.
Improving referrals for women to high-quality centers and increasing gender diversity in cardiothoracic surgery could help reduce this disparity.”
A national study in March 2023 found that the death rate for women undergoing heart bypass surgery increased from 2011 to 2020. A call to action published in JAMA Surgery described these findings as a wake-up call for all healthcare providers who treat women.
In November 2023, the White House launched its first-ever Initiative on Women’s Health to encourage innovation, invest in research, and improve women’s health.
Following this, the Department of Health and Human Services announced a $100 million investment to support research and development in women’s health.
Despite recent improvements in heart surgery outcomes, Dr. Wagner emphasized that there is still a significant gap in outcomes for women.
“Our study shows that better care at low-quality hospitals and fairer referrals of women to high-quality hospitals could help close these long-standing gaps.
It’s an exciting time for research in women’s cardiovascular health, and I am hopeful that with this renewed focus, we will achieve better outcomes for women undergoing heart surgery and improve care for all patients.”
The study was supported by the University of Michigan Institute for Healthcare Policy and Innovation.
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The research findings can be found in JAMA Network Open.
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