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Published on: March 27, 2018
Discharge β-Blocker Use and Race after Coronary Artery Bypass Grafting
Wesley T O'Neal1, Jimmy T Efird2, Stephen W Davies3
1Department of Internal Medicine, Wake Forest School of Medicine , Winston-Salem, NC , USA.
Insights
Discharge beta-blockers improve long-term survival after coronary artery bypass grafting (CABG) for both Black and white patients. The survival benefits of beta-blockers are comparable across racial groups following CABG surgery.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Discharge beta-blockers are linked to improved long-term mortality after cardiac surgery.
- Concerns exist regarding the efficacy of beta-blockers in Black cardiovascular patients compared to White patients.
- Racial disparities in long-term survival among coronary artery bypass grafting (CABG) patients on discharge beta-blockers remain under-examined.
Purpose of the Study:
- To investigate racial differences in long-term survival among CABG patients receiving discharge beta-blockers.
- To compare the effectiveness of discharge beta-blockers in Black versus White patients undergoing CABG.
Main Methods:
- Retrospective cohort study of CABG patients from 2002-2011.
- Comparison of long-term survival between patients discharged with and without beta-blockers.
- Cox regression analysis to compute hazard ratios (HR) and 95% confidence intervals (CI), with p-for-interaction to assess racial differences.
Main Results:
- A total of 4,430 patients (3,460 White, 970 Black) were analyzed; 88% of each group received discharge beta-blockers.
- Black patients on discharge beta-blockers showed a significant survival advantage (adjusted HR=0.33) comparable to White patients (adjusted HR=0.48).
- No significant difference in long-term survival was observed between White and Black patients when both were discharged on beta-blockers (HR=1.2).
Conclusions:
- Discharge beta-blocker use is associated with a significant survival benefit for Black patients post-CABG.
- The survival advantage conferred by discharge beta-blockers is similar for both Black and White patients.
- Beta-blockers are effective in improving long-term outcomes across racial groups after CABG.
Introduction:
The use of discharge β-blockers after cardiac surgery is associated with a long-term mortality benefit. β-Blockers have been suggested to be less effective in black cardiovascular patients compared with whites. To date, racial differences in the long-term survival of coronary artery bypass grafting (CABG) patients who receive β-blockers at discharge have not been examined.
Methods:
A retrospective cohort study was conducted on patients undergoing CABG between 2002 and 2011. Long-term survival was compared in patients who were and who were not discharged with β-blockers. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. P-for-interaction between race and discharge β-blocker use was computed using a likelihood ratio test.
Results:
A total of 853 (88%) black (n = 970) and 3,038 (88%) white (n = 3,460) patients had a history of β-blocker use at discharge (N = 4,430). Black patients who received β-blockers survived longer than those not receiving β-blockers and the survival advantage was comparable with white patients (black, adjusted HR = 0.33, 95% CI = 0.23-0.46; white, adjusted HR = 0.48, 95% CI = 0.39-0.58; p-for-interaction = 0.74). Among patients discharged on β-blockers, we did not observe a long-term survival advantage for white compared with black patients (HR = 1.2, 95% CI = 0.95-1.5).
Conclusion:
β-Blocker use at discharge was associated with a survival advantage among black patients after CABG and a similar association was observed in white patients.
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