The following are key points to remember from a state-of-the-art review on racial and ethnic disparities in perioperative health care among patients undergoing cardiac surgery:

1. Available evidence suggests that there has been little progress in closing the health care disparity gap since the 2003 landmark Institute of Medicine's report Unequal Treatment.
2. Despite the higher burden of cardiovascular disease (CVD) in under-represented 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. Various factors, including racism and social determinants of health, contribute to perioperative health care disparities.
3. This review proposes actionable solutions utilizing multidisciplinary perspectives from cardiology, cardiac surgery, cardiothoracic anesthesiology, critical care, medical ethics, and health disparity experts.
4. In seeking to achieve equitable perioperative outcomes in patients with CVD, it is important to address individual- and system-level factors that contribute to these perioperative health care disparities.
5. There is evidence that when the health care workforce is more representative of the U.S. population and our patients, it has the potential to improve patient outcomes, improve medical decision-making, and enhance the focus of research and clinical efforts on populations experiencing suboptimal outcome.
6. Implicit bias training, cultural competency and cultural humility training, and antiracist training should be viewed as harm reduction strategies until the culture in medicine shifts and diversity is improved.
7. Traditional unconscious bias training does not allow progression through these stages and does not support maintenance of behavior change for sustainable changes. For unconscious bias training to produce the intended outcomes, the training should increase awareness, increase self-motivation to reduce the harmful behavior, and provide evidence-based strategies that reduces biases or disrupts its influence on clinical decision-making and communication.
8. A comprehensive approach should include enhanced access to and delivery of high-quality CV care, improved access and timely referral to cardiothoracic surgery and an interventional cardiologist, enhanced patient engagement to address individual-level factors contributing to these perioperative disparities, and prompt referral and access to cardiac rehabilitation.
9. Incorporating racially diverse population-based cohorts in prospective studies that follow patients from disease recognition to intervention can help identify factors associated with disparities in outcomes and to eliminate the system- and individual-level factors that contribute to racial and ethnic health disparities among cardiac surgery patients.
10. Finally, applying a health equity lens to the planning, design, and implementation of all strategies and interventions is essential to reduce disparate cardiac surgical outcomes. Without these careful analyses, well-intentioned creative solutions will not address these gaps and health inequities will persist.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Cardiac Surgical Procedures, Healthcare Disparities

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