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Cantey C. Treatment disparities in severe aortic stenosis with TAVR. Nurse Pract 2024; 49:13-15. [PMID: 38662489 DOI: 10.1097/01.npr.0000000000000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
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Kulkarni A, Arafat M, Hou L, Liang S, Kassotis J. Racial Disparity Among Patients Undergoing Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement in the United States. Angiology 2023; 74:812-821. [PMID: 36426842 DOI: 10.1177/00033197221137025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative to surgical aortic valve replacement (SAVR). However, racial disparities in the utilization of TAVR persist. This meta-analysis attempts to determine whether the prevalence of adverse outcomes (procedure-related complications) represent barriers to the use of TAVR among African Americans (AA). The TAVR cohort consisted of 89.6% Caucasian (C) and 4.7% AA, while the SAVR cohort included 86.9% C and 6.4% AA. The utilization rate (UR) of TAVR was 1.48 and .35 among C and AA, respectively, while the UR of SAVR was 1.44 and .48 among C and AA, respectively. Following TAVR, for AA the odds ratio (OR) was greater for stroke (OR = 1.22, P = .02) and transient ischemic attack (TIA) (OR = 1.57, P < .001) and lower for undergoing the insertion of a permanent pacemaker (OR = .81, P < .001). While there was a significant difference between C and AA in TAVR and SAVR utilization, outcomes between groups following TAVR are comparable; therefore, adverse outcomes do not appear to be a barrier to the use of TAVR among eligible AA.
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Affiliation(s)
- Abha Kulkarni
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Mohammod Arafat
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Linle Hou
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Shiochee Liang
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - John Kassotis
- Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Hassan SMA, Ghunaim A, Verma R, Sicilia A, Yanagawa B. Racial and ethnic differences in aortic stenosis: the tip of the iceberg. Curr Opin Cardiol 2023; 38:103-107. [PMID: 36718619 DOI: 10.1097/hco.0000000000001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW There is a lack of data on the epidemiology and management of severe aortic stenosis (AS) in diverse populations. We summarize the contemporary literature on the racial and ethnic differences in AS prevalence, treatment and outcomes and discuss possible explanations for these disparities to inform future research and improve the delivery of care to under-represented patient groups. RECENT FINDINGS African American (AA) patients have significantly less prevalence of severe AS than White patients whereas paradoxically having higher traditional risk factors for severe AS. Non-White patients have less referral for aortic valve replacement (AVR) after adjusting for clinical and echocardiographic parameters. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are both underutilized in non-White patients. Differences in race and ethnicity have not shown to result in worse in-hospital and long-term survival outcomes after either SAVR or TAVR. SUMMARY Much research is warranted to explore the epidemiology, true prevalence and treatment outcomes of severe AS in diverse populations. Greater inclusion of non-White ethnic groups in the primary analysis of prospective trials is needed. Lastly, further research is warranted to explore the complex causes of racial and ethnic disparities in utilization of surgical and transcatheter interventions.
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Affiliation(s)
- Syed M Ali Hassan
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Rivera FB, Al-Abcha A, Ansay MFM, Magalong JVU, Tang VAS, Ona HM, Miralles KA, Sausa R, Uy RAF, Lerma EV, Collado FMS, McCullough PA, Volgman AS. Transcatheter Aortic Valve Replacement-Associated Acute Kidney Injury: An Update. Cardiorenal Med 2023; 13:143-157. [PMID: 36801854 DOI: 10.1159/000529729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/01/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a relatively novel minimally invasive procedure for the treatment of symptomatic patients with severe aortic stenosis. Although it has been proven effective in improving mortality and quality of life, TAVR is associated with serious complications, such as acute kidney injury (AKI). SUMMARY TAVR-associated AKI is likely due to several factors such as sustained hypotension, transapical approach, volume of contrast use, and baseline low GFR. This narrative review aims to present an overview of the latest literature and evidence regarding the definition of TAVR-associated AKI, its risk factors, and its impact on morbidity and mortality. The review used a systematic search strategy with multiple health-focused databases (Medline, EMBASE) and identified 8 clinical trials and 27 observational studies concerning TAVR-associated AKI. Results showed that TAVR-associated AKI is linked to several modifiable and nonmodifiable risk factors and is associated with higher mortality. A variety of diagnostic imaging modalities have the potential to identify patients at high risk for development of TAVR-AKI; however, there are no existing consensus recommendations regarding their use as of this time. The implications of these findings highlight the importance of identifying high-risk patients for which preventive measures may play a crucial role, and should be maximized. KEY MESSAGE This study reviews the current understanding of TAVR-associated AKI including its pathophysiology, risk factors, diagnostic modalities, and preventative management for patients.
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Affiliation(s)
| | | | | | | | | | - Hannah May Ona
- University of the Philippines College of Medicine, Manila, Philippines
| | | | - Rausche Sausa
- University of the Philippines College of Medicine, Manila, Philippines
| | | | - Edgar V Lerma
- Section of Nephrology, University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Oak Lawn, Illinois, USA
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Jaiswal V, Peng Ang S, Hanif M, Savaliya M, Vadhera A, Raj N, Gera A, Aujla S, Daneshvar F, Ishak A, Subhan Waleed M, Hugo Aguilera-Alvarez V, Naz S, Hameed M, Wajid Z. The racial disparity among post transcatheter aortic valve replacement outcomes: A meta-analysis. IJC HEART & VASCULATURE 2023; 44:101170. [PMID: 36660201 PMCID: PMC9843207 DOI: 10.1016/j.ijcha.2023.101170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/17/2022] [Accepted: 01/01/2023] [Indexed: 01/13/2023]
Abstract
Background Racial disparities have been well described in cardiovascular disease. However, the impact of race on the outcomes post - Transcatheter aortic valve replacement (TAVR) remains unknown. Objective We aim to evaluate the disparity among the race (black and white) post - TAVR. Methods We systematically searched all electronic databases from inception until September 26, 2022. The primary outcome was in-hospital all-cause mortality, and secondary outcomes was myocardial infarction (MI), acute kidney injury (AKI), permanent pacemaker implantation (PPI) or ICD, stroke, vascular complications, and major bleeding. Results A total of three studies with 1,02,009 patients were included in the final analysis. The mean age of patients with white and black patients was 82.65 and 80.45 years, respectively. The likelihood of in-hospital all-cause mortality (OR, 1.01(95 %CI: 0.86-1.19), P = 0.93), stroke (OR, 0.83(95 %CI:0.61-1.13), P = 0.23, I2 = 46.57 %], major bleeding [OR, 1.05(95 %CI:0.92-1.20), P = 0.46), and vascular complications [OR, 0.92(95 %CI:0.81-1.06), P = 0.26), was comparable between white and black patients. However, patients with white race have lower odds of MI (OR, 0.65(95 %CI:0.50-0.84), P < 0.001), and AKI (OR, 0.84(95 %CI:0.74-0.95), P = 0.01) and higher odds of PPI or ICD (OR, 1.16(95 %CI: 1.06-1.27), P < 0.001, I2 = 0 %) compared with black race patients. Conclusion Our findings suggest disparity post - TAVR outcomes existed, and black patients are at higher risk of MI and AKI than white patients.Key Clinical Message:•What is already known on this topic: Disparity has been witnessed among patients with cardiovascular disease. However, no studies have drawn a significant association among post-TAVR patients' outcomes•What this study adds: Among patients who underwent TAVR, there is a difference in the adverse outcomes between black and white race patients. White patients have a lower risk of post-procedure MI and AKI compared with Black patients.•How this study might affect research, practice, or policy: These disparities need to be addressed, and proper guidelines need to be made along with engaging patients with better medical infrastructure and treatment options..
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Affiliation(s)
- Vikash Jaiswal
- JCCR Cardiology, Varanasi, India
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
- Corresponding author at: JCCR Cardiology, Varanasi, India.
| | - Song Peng Ang
- Division of Internal Medicine, Rutgers Health/Community Medical Center, NJ, USA
| | - Muhammad Hanif
- Department of Internal Medicine, SUNY Upstate Medical University, USA
| | - Mittal Savaliya
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Ananya Vadhera
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Nishchita Raj
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Asmita Gera
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Savvy Aujla
- Department of Medicine, Government Medical College Amritsar, Punjab, India
| | | | - Angela Ishak
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Madeeha Subhan Waleed
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | | | - Sidra Naz
- The University of Texas, MD Anderson Cancer Center, Texas, USA
| | - Maha Hameed
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Zarghoona Wajid
- Department of Internal Medicine, Wayne State University School of Medicine, USA
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Affiliation(s)
- Puja B. Parikh
- Division of Cardiovascular Medicine, Department of MedicineStony Brook University Renaissance School of MedicineStony BrookNY
| | - Smadar Kort
- Division of Cardiovascular Medicine, Department of MedicineStony Brook University Renaissance School of MedicineStony BrookNY
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Impact of concomitant aortic stenosis on the management and outcomes of acute myocardial infarction hospitalizations in the United States. AMERICAN HEART JOURNAL PLUS: CARDIOLOGY RESEARCH AND PRACTICE 2022; 23. [PMID: 36404945 PMCID: PMC9673464 DOI: 10.1016/j.ahjo.2022.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective: To evaluate the prevalence, management and outcomes of concomitant aortic stenosis (AS) in admissions with acute myocardial infarction (AMI). Methods: We used the HCUP-NIS database (2000–2017) to identify adult AMI admissions with concomitant AS. Outcomes of interest included prevalence of AS, in-hospital mortality, use of cardiac procedures, hospitalization costs, length of stay, and discharge disposition. Results: Among a total of 11,622,528 AMI admissions, 513,688 (4.4 %) were identified with concomitant AS. Adjusted temporal trends revealed an increase in STEMI and NSTEMI hospitalizations with concomitant AS. Compared to admissions without AS, those with AS were on average older, of female sex, had higher comorbidity, higher rates of NSTEMI (78.9 % vs 62.1 %), acute non-cardiac organ failure, and cardiogenic shock. Concomitant AS was associated with significantly lower use of coronary angiography (45.5 % vs 64.4 %), percutaneous coronary intervention (20.1 % vs 42.5 %), coronary atherectomy (1.7 % vs. 2.8 %) and mechanical circulatory support (3.5 % vs 4.8 %) (all p < 0.001). Admissions with AS had higher rates of coronary artery bypass surgery and surgical aortic valve replacement (5.9 % vs 0.1 %) compared to those without AS. Admissions with AMI and AS had higher in-hospital mortality (9.2 % vs. 6.0 %; adjusted OR 1.12 [95 % CI 1.10–1.13]; p <0.001). Concomitant AS was associated with longer hospital stay, more frequent palliative care consultations and less frequent discharges to home. Conclusions: In this 18-year study, an increase in prevalence of AS in AMI hospitalization was noted. Concomitant AS was associated with lower use of guideline-directed therapies and worse clinical outcomes among AMI admissions.
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Amponsah DK, Crousillat DR, Elmariah S. Racial and Ethnic Disparities in the Treatment of Aortic Stenosis: Current Challenges and Future Strategies for Achieving Equity in Care. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00963-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yong CM, Jaluba K, Batchelor W, Gummipundi S, Asch SM, Heidenreich P. Temporal trends in transcatheter aortic valve replacement use and outcomes by race, ethnicity, and sex. Catheter Cardiovasc Interv 2022; 99:2092-2100. [PMID: 35395131 PMCID: PMC9541424 DOI: 10.1002/ccd.30182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022]
Abstract
Objectives To identify trends in transcatheter aortic valve replacement (TAVR) use and outcomes by race (non‐Hispanic White, Black), ethnicity (Hispanic), and sex over time. Background Despite rapid growth in TAVR use over time, our understanding of its use and outcomes among males and females of underrepresented racial/ethnic groups remains limited. Methods A retrospective analysis of hospitalizations from 2013 to 2017 from the Healthcare Cost and Utilization Project database was performed. Results White patients comprised 65% (n = 2.16 × 107) of all hospitalizations, yet they comprised 83% (n = 176,887) of the admissions for aortic stenosis (p < 0.0001). Among 91,693 hospitalizations for aortic valve replacement, 64,069 were surgical (34.0% female, 7.0% Hispanic, and 5.9% Black) and 27,624 were transcatheter (46.6% female, 4.5% Hispanic, and 4.4% Black). Growth in TAVR volumes was the slowest among minorities and females. Hispanic males, Hispanic females, and White females had the highest in‐hospital mortality (2.7%–3.3%; compared to White males, adjusted odds ratio: Hispanic males 1.9 [1.2–3.0], Hispanic females 1.9 [1.2–3.1], and White females 1.4 [1.2–1.7]). Despite less baseline vascular disease, females of all races/ethnicities had more vascular complications than men (female 5% vs. male 3.5%, p ≤ 0.001). Further adjustment for vascular complications only partially attenuated mortality differences. Black and Hispanic patients had a longer mean length of hospital stay than White patients, which was most pronounced among females. Pacemaker requirements were consistently low among all groups. Conclusion Differences in TAVR growth and outcomes by race, ethnicity, and sex over time highlight areas for focused efforts to close gaps in minimally invasive structural heart disease care.
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Affiliation(s)
- Celina M Yong
- Division of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Karolina Jaluba
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Wayne Batchelor
- Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Santosh Gummipundi
- Division of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Steven M Asch
- Division of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Paul Heidenreich
- Division of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
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10
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The undertreatment of minorities with TAVR: An unfulfilled potential. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 37:13-14. [DOI: 10.1016/j.carrev.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/20/2022]
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Allana SS, Alkhouli M, Alli O, Coylewright M, Horne A, Ijioma N, Kadavath S, Pineda AM, Sanchez C, Schreiber TL, Shah AP, Smith C, Suradi H, Sylvia KE, Young M, Krishnan SK. Identifying opportunities to advance health equity in interventional cardiology: Structural heart disease. Catheter Cardiovasc Interv 2021; 99:1165-1171. [PMID: 34837459 DOI: 10.1002/ccd.30021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/12/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022]
Abstract
Health care practices are influenced by variety of factors. These factors that include social determinants, race and ethnicity, and gender not only affect access to health care but can also affect quality of care and patient outcomes. These are a source of health care disparities. This article acknowledges that these disparities exist in getting optimal care in structural heart disease, reviews the literature and proposes steps that can help reduce these disparities on personal and committee levels.
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Affiliation(s)
- Salman S Allana
- Division of Cardiology, Department of Medicine, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mohamad Alkhouli
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Olueseun Alli
- Novant Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Megan Coylewright
- Department of Cardiology, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | - Aaron Horne
- Division of Cardiology, Department of Medicine, Palestine Regional Medical Center, Palestine, Texas, USA
| | - Nkechi Ijioma
- Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sabeeda Kadavath
- Department of of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andres M Pineda
- Department of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Carlos Sanchez
- Heart and Vascular Service Line, OhioHealth - Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Theodore L Schreiber
- Department of Cardiology, Ascension St. John Hospital Warren Family Physicians, Warren, Michigan, USA
| | - Atman P Shah
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Conrad Smith
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hussam Suradi
- Division of Cardiovascular Medicine, Department of Medicine, Rush University Medical Center/Rush Medical College, Chicago, Illinois, USA
| | - Kristyn E Sylvia
- The Society for Cardiovascular Angiography and Interventions, Washington, District of Columbia, USA
| | - Michael Young
- Division of Cardiology, Department of Medicine, Darthmouth-Hitchcock Health System, Lebanon, New Hampshire, USA
| | - Sandeep K Krishnan
- Director of Structural Heart Program, Heart and Vascular Institute, King's Daughters Medical Center, Ashland, Kentucky, USA
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Govea N, Jotwani R, Bonaparte C, Komlan AG, White RS, Hoyler M. The economic cost of racial disparities in patients undergoing cardiac valve repair or replacement. J Comp Eff Res 2021; 10:1031-1034. [PMID: 34431362 DOI: 10.2217/cer-2021-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nicolas Govea
- Department of Anesthesiology, New York-Presbyterian Weill Cornell Medical Center, NY 10065, USA
| | - Rohan Jotwani
- Department of Anesthesiology, New York-Presbyterian Weill Cornell Medical Center, NY 10065, USA
| | - Christina Bonaparte
- Department of Public Health, School of Public Health, Brown University, Providence, RI 02915, USA
| | | | - Robert S White
- Department of Anesthesiology, New York-Presbyterian Weill Cornell Medical Center, NY 10065, USA
| | - Marguerite Hoyler
- Department of Anesthesiology, New York-Presbyterian Weill Cornell Medical Center, NY 10065, USA
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Czarny MJ, Hasan RK, Post WS, Chacko M, Schena S, Resar JR. Inequities in Aortic Stenosis and Aortic Valve Replacement Between Black/African-American, White, and Hispanic Residents of Maryland. J Am Heart Assoc 2021; 10:e017487. [PMID: 34261361 PMCID: PMC8483496 DOI: 10.1161/jaha.120.017487] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Racial and ethnic inequities exist in surgical aortic valve replacement for aortic stenosis (AS), and early studies have suggested similar inequities in transcatheter aortic valve replacement. Methods and Results We performed a retrospective analysis of the Maryland Health Services Cost Review Commission inpatient data set from 2016 to 2018. Black patients had half the incidence of any inpatient AS diagnosis compared with White patients (incidence rate ratio [IRR], 0.50; 95% CI, 0.48–0.52; P<0.001) and Hispanic patients had one fourth the incidence compared with White patients (IRR, 0.25; 95% CI, 0.22–0.29; P<0.001). Conversely, the incidence of any inpatient mitral regurgitation diagnosis did not differ between White and Black patients (IRR, 1.00; 95% CI, 0.97–1.03; P=0.97) but was significantly lower in Hispanic compared with White patients (IRR, 0.36; 95% CI, 0.33–0.40; P<0.001). After multivariable adjustment, Black race was associated with a lower incidence of surgical aortic valve replacement (IRR, 0.67; 95% CI, 0.55–0.82 P<0.001 relative to White race) and transcatheter aortic valve replacement (IRR, 0.77; 95% CI, 0.65–0.90; P=0.002) among those with any inpatient diagnosis of AS. Hispanic patients had a similar rate of surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients. Conclusions Hospitalization with any diagnosis of AS is less common in Black and Hispanic patients than in White patients. In hospitalized patients with AS, Black race is associated with a lower incidence of both surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients, whereas Hispanic patients have a similar incidence of both. The reasons for these inequities are likely multifactorial.
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Affiliation(s)
- Matthew J Czarny
- Division of Cardiology School of Medicine Johns Hopkins University Baltimore MD
| | - Rani K Hasan
- Division of Cardiology School of Medicine Johns Hopkins University Baltimore MD
| | - Wendy S Post
- Division of Cardiology School of Medicine Johns Hopkins University Baltimore MD
| | - Matthews Chacko
- Division of Cardiology School of Medicine Johns Hopkins University Baltimore MD
| | - Stefano Schena
- Division of Cardiothoracic Surgery School of Medicine Johns Hopkins University Baltimore MD
| | - Jon R Resar
- Division of Cardiology School of Medicine Johns Hopkins University Baltimore MD
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Goitia J, Phan DQ, Lee MS, Moore N, Mansukhani P, Aharonian V, Brar SS, Zadegan R. The role of neighborhood disadvantage in predicting mortality in patients after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2021; 98:E938-E946. [PMID: 34259367 DOI: 10.1002/ccd.29872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/10/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neighborhoods have a powerful impact on health. Prior investigations into disparities associated with transcatheter aortic valve replacement (TAVR) have focused on race and access to the procedure. We sought to investigate the role of neighborhood disadvantage on mortality post-TAVR. METHODS Patients who underwent TAVR at Kaiser Permanente Los Angeles Medical Center between June, 2011 and March, 2019 were evaluated. Neighborhood disadvantage was defined using the area deprivation index, an established and validated index that considers multiple socioeconomic metrics. Cutoffs used for disadvantage were national percentile ≥25% and state decile ≥6. Cox proportional hazards regression analysis was used to assess outcomes. RESULTS A total of 668 patients (age 82.1 ± 7.5 years, 49% female) were included, of which 215 (32.2%) were from disadvantaged neighborhoods by state decile, and 167 (25%) by national percentile. At a median follow-up of 18.8 months (interquartile range 8.7-36.5 months), neighborhood disadvantage was independently associated with increased all-cause mortality (National percentile: hazard ratio [HR] 1.91, 95% confidence interval [CI] 1.35-2.69; state decile: HR 1.68, 95% CI 1.21-2.34). On propensity scored analysis, neighborhood disadvantaged remained independently associated with increased all-cause mortality (National percentile: IPTW HR 1.86, 95% CI 1.52-2.28, PSM HR 1.67, 95% CI 1.11-2.51; state decile: IPTW HR 1.55, 95% CI 1.26-1.91, PSM HR 2.0, 95% CI 1.33-2.99). CONCLUSION Living in a disadvantaged neighborhood was independently associated with increased mortality post-TAVR on multivariate and propensity score matched analysis. Further investigations into the role of neighborhood disadvantage are needed to address disparities and improve outcomes post-TAVR.
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Affiliation(s)
- Jesse Goitia
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Derek Q Phan
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Naing Moore
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Prakash Mansukhani
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Vicken Aharonian
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Somjot S Brar
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Ray Zadegan
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
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Ullah W, Al-Khadra Y, Mir T, Darmoch F, Pacha HM, Sattar Y, Ijioma N, Mohamed MO, Kwok CS, Asfour AI, Kapadia S, Rizik D, Zehr K, Mamas MA, Alraies MC. Temporal trends in utilization and outcomes of transcatheter aortic valve replacement in different races: an analysis of the national inpatient sample. J Cardiovasc Med (Hagerstown) 2021; 22:586-593. [PMID: 34076606 DOI: 10.2459/jcm.0000000000001172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM We sought to determine the racial and ethnical disparities in the delivery of TAVR and to evaluate the in-hospital outcomes and utilization of TAVR stratified by patient ethnicity. METHOD Using a national inpatient sample database between 2011 and 2015, we identified all adult patients who had TAVR. Races were identified and white race was set as control. Multiple logistic regression analysis was performed for the primary outcome of in-hospital mortality. RESULTS Out of 58 174 patients who underwent TAVR, 50 809 (87.3%) were white, 2327 (4.0%) were black, 2311 (4.0%) were Hispanic, 640 (1.1%) Asian, 105 (0.2%) Native American and 1982 (3.4%) of other ethnicities. We found a statistically significant linear uptrend in the utilization of TAVR in patients of all races between the years 2011 and 2015. White, black, Hispanic and Native American patients had a downward linear trend for mortality during the studied years (P ≤ 0.005 for all). Black patients had lower in-hospital mortality [2.8 vs. 3.6%, odds ratio (OR) = 0.62; 95% confidence interval (CI) 0.44, 0.81 P < 0.001] compared with white patients, whereas Hispanic patients and Native Americans had higher in-hospital mortality compared with white patients (4.5% OR 1.26; 95% CI 1.01, 1.56 P = 0.041), (9.5% OR 4.44; 95% CI 2.25, 8.77 P < 0.001), respectively. CONCLUSION Overall, TAVR utilization is associated with lower mortality. There is a rising trend in utilization of TAVR in the black population with a significantly favorable mortality trend compared with the white population.
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Affiliation(s)
- Waqas Ullah
- Division of Cardiology, Abington Jefferson Health, Abington, Pennsylvania
| | - Yasser Al-Khadra
- Division of Cardiology, Cleveland Clinic, Internal Medicine, Cleveland, Ohio
| | - Tanveer Mir
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Fahed Darmoch
- Division of Cardiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Homam M Pacha
- Division of Cardiology, University of Texas Health Science Center, Houston, Texas
| | - Yasar Sattar
- Division of Cardiology, Icahn School of Medicine at Mount Sinai Elmhurst Hospital New York, New York, New York
| | - Nketchi Ijioma
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamed O Mohamed
- Division of Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chun S Kwok
- Division of Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | - Samir Kapadia
- Division of Cardiology, Abington Jefferson Health, Abington, Pennsylvania
| | - David Rizik
- Division of Cardiology, HonorHealth, Phoenix, Arizona, USA
| | - Kenton Zehr
- Division of Cardiology, Cleveland Clinic, Internal Medicine, Cleveland, Ohio
| | - Mamas A Mamas
- Division of Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - M Chadi Alraies
- Division of Cardiology, Cleveland Clinic, Internal Medicine, Cleveland, Ohio
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16
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Ali A, Mather JF, McMahon S, Curtis LE, Hoover N, Ayer C, Amer MR, Dibble T, Roper L, Orlando R, McKay RG. Racial and ethnic disparities in the use of transcatheter aortic valve replacement in the State of Connecticut. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:7-12. [PMID: 34246611 DOI: 10.1016/j.carrev.2021.06.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although prior national reports have identified trends in the underutilization of transcatheter aortic valve replacement (TAVR) in Afro-American and Latino populations, racial and ethnic healthcare disparities in TAVR use in the State of Connecticut have not been previously reported. METHODS We conducted a retrospective analysis of 1461 patients undergoing TAVR at our institute between from 2012 to 2020. Baseline demographics, procedural characteristics, clinical outcomes, median incomes and insurance coverage were compared between 1417 Caucasian and 44 minority patients, including 23 patients designated as Afro-American and 10 designated as Latino. Demographics of TAVR utilization at our institution were further compared to 6 additional Connecticut TAVR centers using Connecticut Hospital Association (CHA) ChimeData detailing hospital discharges for DRG 266 and 267. RESULTS In comparison to Caucasian patients, minority cohorts were younger (75.7 ± 9.0 vs 81.5 ± 5.1 years, p < 0.001) and had more co-morbidities including diabetes (64% vs 34%, p < 001), coronary artery disease (95% vs 78%, p = 0.039), end stage renal disease requiring dialysis (9% vs 3%, p = 0.009) and atrial fibrillation (77% vs 62%, p = 0.041). The two groups did not differ with respect to other risk factors or co-morbidities, baseline echocardiographic or CTA findings, STS risk score, or procedural technique. Minority patients had a longer length of hospital stay (9.5 ± 9.0 vs 6.4 ± 6.9 days, p = 0.003), but did not differ with respect to procedural complications. Socioeconomic differences between the two groups included lower median incomes and higher rates of Medicaid or no insurance coverage for minority versus Caucasian patients. CHA ChimeData revealed a similar underutilization of TAVR in minority subgroups in the remaining 6 Connecticut TAVR centers. CONCLUSIONS Despite statewide demographics describing 10.7% and 15.7% of the total population as Afro-American and Latino, respectively, only 3.0% of the total TAVR procedures performed at a large Connecticut health care facility were performed in minority subgroups. Despite having a higher burden of co-morbidities, minority patients had similar outcomes compared to Caucasian patients. Similar racial and ethnic disparities in TAVR utilization were confirmed statewide using CHA ChimeData.
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Affiliation(s)
- Abdelrahman Ali
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America.
| | - Jeffrey F Mather
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Sean McMahon
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Lauren E Curtis
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Nicole Hoover
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Courtney Ayer
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Mostafa R Amer
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Tina Dibble
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Lizabeth Roper
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Rocco Orlando
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
| | - Raymond G McKay
- Divisions of Medicine, Cardiology, Surgery and Research Administration, Hartford Hospital, Hartford, CT, United States of America
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Matthew Brennan J, Leon MB, Sheridan P, Boero IJ, Chen Q, Lowenstern A, Thourani V, Vemulapalli S, Thomas K, Wang TY, Peterson ED. Racial Differences in the Use of Aortic Valve Replacement for Treatment of Symptomatic Severe Aortic Valve Stenosis in the Transcatheter Aortic Valve Replacement Era. J Am Heart Assoc 2020; 9:e015879. [PMID: 32777969 PMCID: PMC7660794 DOI: 10.1161/jaha.119.015879] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/19/2020] [Indexed: 12/11/2022]
Abstract
Background Aortic valve replacement (AVR) is a life-saving treatment for patients with symptomatic severe aortic valve stenosis. We sought to determine whether transcatheter AVR has resulted in a more equitable treatment rate by race in the United States. Methods and Results A total of 32 853 patients with symptomatic severe aortic valve stenosis were retrospectively identified via Optum's deidentified electronic health records database (2007-2017). AVR rates in non-Hispanic Black and White patients were assessed in the year after diagnosis. Multivariate Fine-Gray hazards models were used to evaluate the likelihood of AVR by race, with adjustment for patient factors and the managing cardiologist. Time-trend and 1-year symptomatic severe aortic valve stenosis survival analyses were also performed. From 2011 to 2016, the rate of AVR increased from 20.1% to 37.1%. Overall, Black individuals were less likely than Whites to receive AVR (22.9% versus 31.0%; unadjusted hazard ratio [HR], 0.70; 95% CI, 0.62-0.79; fully adjusted HR, 0.76; 95% CI, 0.67-0.85). Yet, during 2015 to 2016, AVR racial differences were attenuated (29.5% versus 35.2%; adjusted HR, 0.86; 95% CI, 0.74-1.02) because of greater uptake of transcatheter AVR in Blacks than Whites (53.4% of AVRs versus 47.3%; P=0.128). Untreated patients had significantly higher 1-year mortality than those treated (adjusted HR, 0.57; 95% CI, 0.53-0.61), which was consistent by race (interaction P value=0.52). Conclusions Although transcatheter AVR has increased the use of AVR in the United States, treatment rates remain low. Black patients with symptomatic severe aortic valve stenosis were less likely than White patients to receive AVR, yet these differences have recently narrowed.
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Affiliation(s)
| | - Martin B. Leon
- Columbia University Medical Center and New York Presbyterian HospitalNew YorkNY
| | - Paige Sheridan
- Department of Family Medicine and Public HealthUniversity of San DiegoSan DiegoCA
- Boston Consulting GroupBostonMA
| | | | | | | | - Vinod Thourani
- Georgetown University School of MedicineMedstar Heart and Vascular InstituteWashingtonDC
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Batchelor W, Anwaruddin S, Ross L, Alli O, Young MN, Horne A, Cestoni A, Welt F, Mehran R. Aortic Valve Stenosis Treatment Disparities in the Underserved. J Am Coll Cardiol 2019; 74:2313-2321. [DOI: 10.1016/j.jacc.2019.08.1035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
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19
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Batchelor W, Ekanem E. TAVR Use and Outcomes in Minorities: Time for a Wake-up Call. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:537-538. [PMID: 31349893 DOI: 10.1016/j.carrev.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/19/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Wayne Batchelor
- Inova Heart and Vascular Institute, Falls Church, Virginia, U.S.A..
| | - Emmanuel Ekanem
- Inova Heart and Vascular Institute, Falls Church, Virginia, U.S.A
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20
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Alkhouli M, Alqahtani F, Holmes DR, Berzingi C. Racial Disparities in the Utilization and Outcomes of Structural Heart Disease Interventions in the United States. J Am Heart Assoc 2019; 8:e012125. [PMID: 31315490 PMCID: PMC6761641 DOI: 10.1161/jaha.119.012125] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Data on race‐ and ethnicity‐based disparities in the utilization and outcomes of structural heart disease interventions in the United States are scarce. Methods and Results We used the National Inpatient Sample (2011‐2016) to examine racial and ethnic differences in the utilization, in‐hospital outcomes, and cost of structural heart disease interventions among patients ≥65 years of age. A total of 106 119 weighted hospitalizations for transcatheter aortic valve replacement, transcatheter mitral valve repair, and left atrial appendage occlusion were included. The utilization rates (defined as the number of procedures performed per 100 000 US people >65 years of age) were higher in whites compared with blacks and Hispanics for transcatheter aortic valve replacement (43.1 versus 18.0 versus 21.1), transcatheter mitral valve repair (5.0 versus 3.2 versus 3.2), and left atrial appendage occlusion (6.6 versus 2.1 versus 3.5), respectively (P<0.001). Black and Hispanic patients had distinctive socioeconomic and clinical risk profiles compared with white patients. There were no significant differences in the adjusted in‐hospital mortality or key complications between patients of white race, black race, and Hispanic ethnicity following transcatheter aortic valve replacement, transcatheter mitral valve repair, or left atrial appendage occlusion. No difference in cost was observed between white and black patients following any of the 3 procedures. However, Hispanic patients incurred modestly higher cost with transcatheter mitral valve repair and left atrial appendage occlusion compared with white patients. Conclusions Racial and ethnic disparities exist in the utilization of structural heart disease interventions in the United States. Nonetheless, adjusted in‐hospital outcomes were comparable among white, black, and Hispanic patients. Further studies are needed to understand the reasons for these utilization disparities.
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Affiliation(s)
- Mohamad Alkhouli
- Division of CardiologyDepartment of MedicineWest Virginia UniversityMorgantownWV
- Department of CardiologyMayo Clinic School of MedicineRochesterMN
| | - Fahad Alqahtani
- Division of CardiologyDepartment of MedicineWest Virginia UniversityMorgantownWV
| | - David R. Holmes
- Department of CardiologyMayo Clinic School of MedicineRochesterMN
| | - Chalak Berzingi
- Division of CardiologyDepartment of MedicineWest Virginia UniversityMorgantownWV
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Alkhouli M, Holmes DR, Carroll JD, Li Z, Inohara T, Kosinski AS, Szerlip M, Thourani VH, Mack MJ, Vemulapalli S. Racial Disparities in the Utilization and Outcomes of TAVR. JACC Cardiovasc Interv 2019; 12:936-948. [DOI: 10.1016/j.jcin.2019.03.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/25/2019] [Accepted: 03/05/2019] [Indexed: 12/20/2022]
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Hernandez-Suarez DF, Ranka S, Villablanca P, Yordan-Lopez N, González-Sepúlveda L, Wiley J, Sanina C, Roche-Lima A, Nieves-Rodriguez BG, Thomas S, Cox-Alomar P, Lopez-Candales A, Ramakrishna H. Racial/Ethnic Disparities in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights from the Healthcare Cost and Utilization Project's National Inpatient Sample. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:546-552. [PMID: 30987828 DOI: 10.1016/j.carrev.2019.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify racial/ethnic disparities in utilization rates, in-hospital outcomes and health care resource use among Non-Hispanic Whites (NHW), African Americans (AA) and Hispanics undergoing transcatheter aortic valve replacement (TAVR) in the United States (US). METHODS AND RESULTS The National Inpatient Sample database was queried for patients ≥18 years of age who underwent TAVR from 2012 to 2014. The primary outcome was all-cause in hospital mortality. A total of 36,270 individuals were included in the study. The number of TAVR performed per million population increased in all study groups over the three years [38.8 to 103.8 (NHW); 9.1 to 26.4 (AA) and 9.4 to 18.2 (Hispanics)]. The overall in-hospital mortality was 4.2% for the entire cohort. Race/ethnicity showed no association with in-hospital mortality (P > .05). Though no significant difference were found between AA and NHW in any secondary outcome, being Hispanic was associated with higher incidence of acute myocardial infarction (aOR = 2.02; 95% CI, 1.06-3.85; P = .03), stroke/transient ischemic attack (aOR = 1.81; 95% CI, 1.04-3.14; P = .04), acute kidney injury (aOR = 1.65; 95% CI, 1.23-2.21; P < .01), prolonged length of stay (aOR = 1.18; 95% CI, 1.08-1.29; P < .01) and higher hospital costs (aOR = 1.27; 95% CI, 1.18-1.36; P < .01). CONCLUSION There are significant racial disparities in patients undergoing TAVR in the US. Though in-hospital mortality was not associated with race/ethnicity, Hispanic patients had less TAVR utilization, higher in-hospital complications, prolonged length of stay and increased hospital costs.
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Affiliation(s)
- Dagmar F Hernandez-Suarez
- Division of Cardiovascular Medicine, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, PR, USA.
| | - Sagar Ranka
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | | | - Lorena González-Sepúlveda
- Puerto Rico Clinical and Translational Research Consortium (PRCTRC), University of Puerto Rico, San Juan, PR, USA
| | - Jose Wiley
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Cristina Sanina
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Abiel Roche-Lima
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Brenda G Nieves-Rodriguez
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Stacey Thomas
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, AZ, USA
| | - Pedro Cox-Alomar
- Division of Cardiology, Department of Medicine, Louisiana State University, New Orleans, LA, USA
| | - Angel Lopez-Candales
- Division of Cardiovascular Medicine, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, AZ, USA
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Aortic Stenosis in African Americans: Focus On Disparities in Treatment and Outcomes. J Natl Med Assoc 2018; 111:328-333. [PMID: 30591233 DOI: 10.1016/j.jnma.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/30/2018] [Accepted: 11/15/2018] [Indexed: 11/21/2022]
Abstract
Aortic stenosis (AS) is the third most common type of cardiovascular disease after hypertension and coronary artery disease, and it carries a high mortality rate when left untreated. Risk factors include male sex, hypertension, tobacco use, advanced age, elevated LDL cholesterol, and coronary atherosclerosis. Definitive treatment for AS includes valve repair, either percutaneously or surgically; however, in aging populations corrective surgery carries increased risk. While research suggests that patients of some non-White ethnic groups, including African-Americans, are less likely than their Caucasian counterparts to have AS, these minority patients may experience may experience differences in the way they receive and accept care. This paper seeks to explicate the mechanisms of racial disparities among the African-Americans affected by aortic stenosis as they pertain to healthcare utilization, referral for valve replacement, acceptance of therapy, and overall treatment outcomes.
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Alqahtani F, Aljohani S, Amin AH, Al-Hijji M, Ali OO, Holmes DR, Alkhouli M. Effect of Race on the Incidence of Aortic Stenosis and Outcomes of Aortic Valve Replacement in the United States. Mayo Clin Proc 2018; 93:607-617. [PMID: 29506780 DOI: 10.1016/j.mayocp.2017.11.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/28/2017] [Accepted: 11/09/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the effect of race on the incidence of aortic stenosis (AS) and utilization and outcomes of aortic valve replacement (AVR). PATIENTS AND METHODS Patients older than 60 years hospitalized with a primary diagnosis of AS and those who underwent AVR between 2003 and 2014 were included. Adjusted and unadjusted incidence of AS-related hospitalizations, utilization rates of AVR, in-hospital morbidity and mortality, and resource utilization was compared between whites and African Americans (AAs). RESULTS Between January 1, 2003, and December 31, 2014, the incidence of AS-related admissions increased from 13 (95% CI, 12.8-13.2) to 26 (95% CI, 25.7-26.4) cases per 100,000 patient-years in whites and from 3 (95% CI, 3.5-3.8) to 9.5 (95% CI, 9.4-9.8) cases per 100,000 patient-years in AAs (P<.001). The incidence density ratio decreased from 4.3 (95% CI, 2.27-6.6) in 2003 to 2.7 (95% CI, 1.1-3.8) in 2014. The ratio of AVR to AS-related admissions was 11.3% in whites and 6.7% in AAs (P<.001). Crude in-hospital mortality after AVR was higher in AAs (6.4% vs 4.7%; P<.001). However, after propensity score matching, in-hospital morality after isolated AVR was not significantly different between AAs and whites (4.7% vs 3.7%; P=.12). African Americans also had longer hospitalizations (12±12 days vs 10±9 days; P<.001), higher rates of nonhome discharge (32.1% vs 27.2%; P=.004), and higher cost of hospitalization ($55,631±$37,773 vs $52,521±$38,040; P<.001). CONCLUSIONS African Americans undergo AVR less than whites. The underlying etiology of this disparity is multifactorial, but may be related to a lower incidence of AS in AAs. Aortic valve replacement is associated with similar risk-adjusted in-hospital mortality but higher cost and longer hospitalizations in AAs than in whites.
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Affiliation(s)
- Fahad Alqahtani
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Sami Aljohani
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Ali Hama Amin
- Division of Cardiology, West Virginia University, Morgantown, WV
| | | | - Oluseun O Ali
- Novant Health Heart & Vascular Institute, Charlotte, NC
| | | | - Mohamad Alkhouli
- Division of Cardiology, West Virginia University, Morgantown, WV; Department of Cardiology, Mayo Clinic, Rochester, MN.
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Bob-Manuel T, Sharma A, Nanda A, Ardeshna D, Skelton WP, Khouzam RN. A review of racial disparities in transcatheter aortic valve replacement (TAVR): accessibility, referrals and implantation. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:10. [PMID: 29404356 DOI: 10.21037/atm.2017.10.17] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Racial disparities in transcatheter aortic valve replacement (TAVR) implantation results from several factors, including socioeconomic disparities, inherent biases in healthcare provision, fewer referrals to specialists and language barriers in some minority populations. In this review article, we discuss the current data on the racial disparities in TAVR, explore the prevalence of aortic stenosis in different demographics in the United States and we proffer practical solutions to these problems.
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Affiliation(s)
- Tamunoinemi Bob-Manuel
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Arindam Sharma
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Amit Nanda
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Devarshi Ardeshna
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - William Paul Skelton
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Rami N Khouzam
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Internal Medicine, Division of Cardiology, University of Tennessee Health Science Center, Memphis, TN, USA
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