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Prabhakar AP, Lopez-Candales A. Calcific aortic valve disease and cardiometabolic triggers: an explanation behind progression of aortic valvular disease and failure of medical therapy interventions. Postgrad Med 2024:1-9. [PMID: 39297302 DOI: 10.1080/00325481.2024.2406740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 09/17/2024] [Indexed: 09/25/2024]
Abstract
Calcific aortic valve disease (CAVD), a nonrheumatic stenosis of the trileaflet aortic valve, is a complex, multifaceted cardiovascular condition involving a widespread inflammatory process and an analogous atheromatous process affecting the arteries. It is currently the most encountered valvular abnormality in cardiology. Although distinctive abnormal mechanical forces are at the core propelling a responsive mechanosensitive feedback cascade, implicated in both initiation and perpetuation of CAVD; we propose a conundrum of metabolic abnormalities including hypertension, elevated fasting blood sugar, decreased high-density lipoprotein, hypertriglyceridemia, and abdominal obesity as perpetuators of this process. Furthermore, we suggest CAVD as a cardio metabolic disorder. New perspectives as well as which pathways we believe are critically involved and ideas for early intervention are discussed.
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Affiliation(s)
- Akruti Patel Prabhakar
- Advanced Cardiac Imaging Research Fellow, Department of Cardiovascular Medicine, University of Louisville, Louisville, KY, USA
| | - Angel Lopez-Candales
- Cardiology Section, Dayton VA Medical Center, Wright State Boonshoft School of Medicine, Dayton, OH, USA
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Faloye AO, Houston BT, Milam AJ. Racial and Ethnic Disparities in Cardiovascular Care. J Cardiothorac Vasc Anesth 2024; 38:1623-1626. [PMID: 38876812 DOI: 10.1053/j.jvca.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 06/16/2024]
Affiliation(s)
| | - Bobby T Houston
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | - Adam J Milam
- Department of Anesthesiology and Perioperative Medicine; Mayo Clinic; Phoenix, AZ
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Li R, Luo Q, Huddleston SJ. African Americans have worse outcomes after transcatheter and surgical aortic valve replacement: A national inpatient sample analysis from 2015 to 2020. J Cardiol 2024; 84:105-112. [PMID: 38373538 DOI: 10.1016/j.jjcc.2024.02.003] [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: 11/20/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Racial disparities in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are controversial among African Americans (AA). This study investigated racial disparities comparing AA and Caucasians undergoing aortic valve replacement. METHODS Patients who underwent SAVR and TAVR for aortic stenosis were identified in National Inpatient Sample from Q4 2015-2020. In-hospital perioperative outcomes, length of stay, days from admission to operation, and total hospital charge, were compared between AA and Caucasians using multivariable analysis, adjusting for sex, age, socioeconomic status, comorbidity, and hospital characteristics. RESULTS In TAVR, 51,394 (84.41 %) were Caucasians and 2433 (4.00 %) were AA. In SAVR, there were 50,080 (78.52 %) Caucasians and 3565 (5.59 %) AA. Compared to Caucasians, AA underwent TAVR had a higher risk of complications such as major adverse cardiovascular events (MACE) [adjusted odds ratio (aOR) = 1.335, p = 0.02)], respiratory complications (aOR = 1.363, p = 0.01), acute kidney injury (AKI) (aOR = 1.468, p < 0.01), pulmonary embolism (aOR = 4.65, p = 0.05), hemorrhage/hematoma (aOR = 1.202, p < 0.01), or superficial wound complication (aOR = 1.414, p = 0.04). AA who underwent SAVR had higher risks of morality (aOR = 1.184, p < 0.05) and surgical complications including MACE (aOR = 1.263, p < 0.01), pericardial complications (aOR = 1.563, p < 0.01), cardiogenic shock (aOR = 1.578, p < 0.01), respiratory complications (aOR = 1.261, p < 0.01), AKI (aOR = 1.642, p < 0.01), venous thromboembolism (aOR = 1.613, p < 0.01), hemorrhage/hematoma (aOR = 1.129, p < 0.01), infection (aOR = 1.234, p < 0.01), superficial wound complications (aOR = 1.756, p < 0.01), vascular complications (aOR = 1.592, p < 0.01), and diaphragmatic paralysis (aOR = 2.181, p = 0.02). In both TAVR and SAVR, AA had longer waiting times from admission to operation (p < 0.01), longer hospital stays (p < 0.01), and higher hospital charges (p < 0.01). CONCLUSION AA were underrepresented, especially in TAVR. AA experienced higher in-hospital mortality post-SAVR, but not after TAVR. Furthermore, AA had more complications for both TAVR and SAVR. These findings underscore the pronounced disparities among AA in aortic valve replacement.
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Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Qianyun Luo
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Stephen J Huddleston
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
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Scott SS, Gouchoe DA, Azap L, Henn MC, Choi K, Mokadam NA, Whitson BA, Pawlik TM, Ganapathi AM. Racial and Ethnic Disparities in Peri-and Post-operative Cardiac Surgery. CURRENT CARDIOVASCULAR RISK REPORTS 2024; 18:95-113. [PMID: 39100592 PMCID: PMC11296970 DOI: 10.1007/s12170-024-00739-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/06/2024]
Abstract
Purpose of Review Despite efforts to curtail its impact on medical care, race remains a powerful risk factor for morbidity and mortality following cardiac surgery. While patients from racial and ethnic minority groups are underrepresented in cardiac surgery, they experience a disproportionally elevated number of adverse outcomes following various cardiac surgical procedures. This review provides a summary of existing literature highlighting disparities in coronary artery bypass surgery, valvular surgery, cardiac transplantation, and mechanical circulatory support. Recent Findings Unfortunately, specific causes of these disparities can be difficult to identify, even in large, multicenter studies, due to the complex relationship between race and post-operative outcomes. Current data suggest that these racial/ethnic disparities can be attributed to a combination of patient, socioeconomic, and hospital setting characteristics. Summary Proposed solutions to combat the mechanisms underlying the observed disparate outcomes require deployment of a multidisciplinary team of cardiologists, anesthesiologists, cardiac surgeons, and experts in health care equity and medical ethics. Successful identification of at-risk populations and the implementation of preventive measures are necessary first steps towards dismantling racial/ethnic differences in cardiac surgery outcomes.
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Affiliation(s)
- Shane S. Scott
- Medical Scientist Training Program, Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH USA
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Doug A. Gouchoe
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
- COPPER Laboratory, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Lovette Azap
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Matthew C. Henn
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Kukbin Choi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Nahush A. Mokadam
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Bryan A. Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
- COPPER Laboratory, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Asvin M. Ganapathi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
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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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Li R, Choi BG. Native Americans have comparable transcatheter aortic valve replacement outcomes but higher stroke and venous thromboembolism after surgical aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 62:11-17. [PMID: 38052718 DOI: 10.1016/j.carrev.2023.12.001] [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] [Received: 10/09/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Racial disparities in aortic valve replacement outcomes have been established. However, the current literature lacks comprehensive studies that examine the outcomes for Native Americans, probably due to their limited population size. This study aimed to investigate whether disparities in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) also exist for outcomes among Native Americans. METHODS Patients who underwent SAVR and TAVR were identified in National Inpatient Sample from the last quarter of 2015 to 2020. A 1:5 propensity score matching was conducted between Native Americans and Caucasians. In-hospital perioperative outcomes, length of stay, wait from admission to operation, and total hospital charge, were compared. RESULTS In TAVR, 51,394 (84.41 %) were Caucasians and 171 (0.28 %) were Native Americans. In SAVR, there were 50,080 (78.52 %) Caucasians and 279 (0.44 %) Native Americans. After propensity matching, no significant difference was found in post-TAVR outcomes between Native Americans and Caucasians. However, Native Americans have a higher risk of neurological complications (2.88 % vs 0.79 %, p < 0.01) with stroke being the primary contributor (2.52 % vs 0.5 %, p < 0.01), as well as a higher incidence of venous thromboembolism (1.8 % vs 0.57 %, p < 0.05) after SAVR. CONCLUSIONS This study is the first to examine aortic valve replacement outcomes in Native Americans. Native Americans were found to be more likely to undergo SAVR than TAVR. Moreover, Native Americans were found to have five times higher stroke and three times higher VTE after SAVR. These disparities faced by Native Americans underscore the need for increased attention and targeted actions to guarantee health equity.
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Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America.
| | - Brian G Choi
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
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Antia A, Pius R, Ndukauba C, Zarauz VR, Olafiranye O. Temporal trends in the utilization and outcome of transcatheter aortic valve replacement across racial and ethnic groups. A nationwide analysis. Int J Cardiol 2024; 399:131669. [PMID: 38141727 DOI: 10.1016/j.ijcard.2023.131669] [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: 10/29/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Transcatheter aortic valvular replacement (TAVR) improves outcomes in patients with aortic stenosis (AS). However, data describing racial disparities in the utilization and outcomes of TAVR are limited. We aimed to evaluate the utilization trends and outcomes of TAVR across racial and ethnic groups. METHODS All patients who underwent TAVR in the United States from 2016 through 2020 were identified from the National Inpatient Sample database. Patients were classified according to their racial and ethnic groups as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, and Asian. We assessed racial and ethnic differences in the outcomes of TAVR using multivariate logistic regression analysis adjusting for age, sex, insurance, income, hospital location and teaching status, bed size, region, and the Charlson Comorbidity Index. RESULTS Of the 280,290 patients who underwent TAVR, 89.5% were NHW, 4.24% were NHB, 4.9% were Hispanic, and 1.39% were Asian people. In 2016, the rates of all-TAVR procedures were 1.48 per 1000 patients among NHW group but 0.39 in NHB, 0.4 in Hispanic, and 0.47 in the Asian group. A steep rise was noted in the rate of TAVR among NHW but not in the NHB, Hispanic, and Asian groups. NHB patients had lower mortality rates (adjusted Odds Ratio [aOR]: 0.56; CI 0.35-0.88 p = 0.014) compared to their NHW counterparts. CONCLUSION The racial and ethnic gap in the utilization of TAVR widened during the study period with minority groups being disproportionately less likely to receive TAVR. NHB patients who received TAVR had lower mortality rates than NHW.
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Affiliation(s)
- Akanimo Antia
- Department of Medicine, Lincoln Medical Center, Bronx, NY, USA.
| | - Ruth Pius
- Department of Medicine, Lincoln Medical Center, Bronx, NY, USA
| | | | | | - Oladipupo Olafiranye
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center and Veterans Affairs North Texas Healthcare System, Dallas, TX, USA
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Ram C, Yousef S, Ma WG, Vallabhajosyula I, Singh S, Agarwal R, Milewski RK, Assi R, Patel PA, Williams M, Geirsson A, Vallabhajosyula P. Living in disadvantaged neighborhoods linked to less intervention for severe aortic stenosis. Sci Rep 2024; 14:4952. [PMID: 38418864 PMCID: PMC10902341 DOI: 10.1038/s41598-024-52660-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
To investigate the association between area deprivation index (ADI) and aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). Patients aged 40-95 years with severe AS confirmed by echocardiography were included. The 9-digit zip code of patient residence address was used to identify the ADI ranking, based on which patients were divided into 5 groups (with Group E being most deprived). The rates of AV intervention were compared among 5 groups using competing risks analysis, with death as a competing event. We included 1751 patients with severe AS from 2013 to 2018 followed for a median 2.8 (interquartile range, 1.5-4.8) years. The more distressed ADI groups tended to be younger (P = 0.002), female (P < 0.001), and of African American race (P < 0.001), have higher presentation of sepsis (P = 0.031), arrhythmia (P = 0.022), less likely to have previous diagnosis of AS (P < 0.001); and were less likely to undergo AVR (52.5% vs 46.9% vs 46.1% vs 48.9% vs 39.7%, P = 0.023). Using competing risk analysis, the highest ADI group (E) were the least and the lowest ADI group (A) the most likely to undergo AVR (Gray's test, P = 0.025). The association between ADI ranking and AVR rates was influenced by sex and race. Within group analysis, there was significant association between race and AVR (Gray's test, P < 0.001), and between sex and AVR (Gray's test, P < 0.001). Patients with severe AS living in more deprived neighborhoods were less likely to undergo aortic valve interventions, which was influenced by female gender, and African American race.
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Affiliation(s)
- Chirag Ram
- Division of Cardiac Surgery, Yale Aortic Institute, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT, 06520, USA
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sameh Yousef
- Division of Cardiac Surgery, Yale Aortic Institute, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT, 06520, USA
| | - Wei-Guo Ma
- Division of Cardiac Surgery, Yale Aortic Institute, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT, 06520, USA
| | - Ishani Vallabhajosyula
- Division of Cardiac Surgery, Yale Aortic Institute, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT, 06520, USA
| | - Saket Singh
- Division of Cardiac Surgery, Yale Aortic Institute, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT, 06520, USA
| | - Ritu Agarwal
- Joint Data Analytics Team, Information Technology Service, Yale University, New Haven, USA
| | - Rita K Milewski
- Division of Cardiac Surgery, Yale Aortic Institute, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT, 06520, USA
| | - Roland Assi
- Division of Cardiac Surgery, Yale Aortic Institute, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT, 06520, USA
| | - Prakash A Patel
- Division of Cardiac Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Matthew Williams
- Division of Cardiac Surgery, Yale Aortic Institute, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT, 06520, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale Aortic Institute, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT, 06520, USA
| | - Prashanth Vallabhajosyula
- Division of Cardiac Surgery, Yale Aortic Institute, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT, 06520, USA.
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Li R, Luo Q, Yanavitski M, Huddleston SJ. Disparity among Asian Americans in transcatheter and surgical aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 59:84-90. [PMID: 37673721 DOI: 10.1016/j.carrev.2023.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Racial disparities in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) outcomes have been established, but research has predominantly focused on African Americans and Hispanics, leaving a gap in Asian Americans. This study aimed to investigate disparities in aortic valve replacement outcomes among Asian Americans. METHODS Patients who underwent SAVR and TAVR were identified in National Inpatient Sample from the last quarter of 2015-2020. A 1:2 propensity score matching was applied to Asian Americans and Caucasians. In-hospital perioperative outcomes, length of stay, days from admission to operation, and total hospital charge, were compared. RESULTS In TAVR, 51,394 (84.41 %) were Caucasians and 795 (1.31 %) were Asian Americans. In SAVR, there were 50,080 (78.52 %) Caucasians and 1233 (1.93 %) Asian Americans. No significant difference was found in post-TAVR complications. However, Asian Americans experienced longer waiting time until operation (p = 0.03) and higher costs (p < 0.01) in TAVR. In SAVR, Asian Americans had higher risks of in-hospital mortality (3.91 % vs 2.39 %, p = 0.01), cardiogenic shock (8.71 % vs 6.74 %, p = 0.03), respiratory complications (14.08 % vs 11.2 %, p = 0.01), mechanical ventilation (13.83 % vs 9.09 %, p < 0.01), acute kidney injury (25.47 % vs 20.13 %, p < 0.01), and hemorrhage/hematoma (72.01 % vs 62.95 %, p < 0.01). Additionally, Asian Americans underwent SAVR had longer lengths of stay (p < 0.01) and higher costs (p < 0.01). CONCLUSIONS Asian Americans were underrepresented in aortic valve replacement. Asian Americans, while having similar post-TAVR outcomes to Caucasians, faced greater risks of post-SAVR mortality and surgical complications. These disparities among Asian Americans call for targeted actions to ensure equitable health outcomes.
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Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America.
| | - Qianyun Luo
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Marat Yanavitski
- M Health University of Minnesota Physicians, Cardiology East Division, Minneapolis, MN, United States of America
| | - Stephen J Huddleston
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America
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Whelton SP, Jha K, Dardari Z, Razavi AC, Boakye E, Dzaye O, Verghese D, Shah S, Budoff MJ, Matsushita K, Carr JJ, Vasan RS, Blumenthal RS, Anchouche K, Thanassoulis G, Guo X, Rotter JI, McClelland RL, Post WS, Blaha MJ. Prevalence of Aortic Valve Calcium and the Long-Term Risk of Incident Severe Aortic Stenosis. JACC Cardiovasc Imaging 2024; 17:31-42. [PMID: 37178073 PMCID: PMC10902718 DOI: 10.1016/j.jcmg.2023.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Aortic valve calcification (AVC) is a principal mechanism underlying aortic stenosis (AS). OBJECTIVES This study sought to determine the prevalence of AVC and its association with the long-term risk for severe AS. METHODS Noncontrast cardiac computed tomography was performed among 6,814 participants free of known cardiovascular disease at MESA (Multi-Ethnic Study of Atherosclerosis) visit 1. AVC was quantified using the Agatston method, and normative age-, sex-, and race/ethnicity-specific AVC percentiles were derived. The adjudication of severe AS was performed via chart review of all hospital visits and supplemented with visit 6 echocardiographic data. The association between AVC and long-term incident severe AS was evaluated using multivariable Cox HRs. RESULTS AVC was present in 913 participants (13.4%). The probability of AVC >0 and AVC scores increased with age and were generally highest among men and White participants. In general, the probability of AVC >0 among women was equivalent to men of the same race/ethnicity who were approximately 10 years younger. Incident adjudicated severe AS occurred in 84 participants over a median follow-up of 16.7 years. Higher AVC scores were exponentially associated with the absolute risk and relative risk of severe AS with adjusted HRs of 12.9 (95% CI: 5.6-29.7), 76.4 (95% CI: 34.3-170.2), and 380.9 (95% CI: 169.7-855.0) for AVC groups 1 to 99, 100 to 299, and ≥300 compared with AVC = 0. CONCLUSIONS The probability of AVC >0 varied significantly by age, sex, and race/ethnicity. The risk of severe AS was exponentially higher with higher AVC scores, whereas AVC = 0 was associated with an extremely low long-term risk of severe AS. The measurement of AVC provides clinically relevant information to assess an individual's long-term risk for severe AS.
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Affiliation(s)
- Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| | - Kunal Jha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Dhiran Verghese
- Department of Medicine, Harbor University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Sanjiv Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J Budoff
- Department of Medicine, Harbor University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J Jeffery Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ramachandran S Vasan
- University of Texas School of Public Health San Antonio, San Antonio, Texas, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Khalil Anchouche
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor University of California, Los Angeles Medical Center, Torrance, California, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor University of California, Los Angeles Medical Center, Torrance, California, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Wendy S Post
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Movahed MR, Timmerman B, Hashemzadeh M. Independent association of aortic stenosis with many known cardiovascular risk factors and many inflammatory diseases. Arch Cardiovasc Dis 2023; 116:467-473. [PMID: 37749002 DOI: 10.1016/j.acvd.2023.07.008] [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: 04/28/2023] [Revised: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Aortic valve stenosis is associated with age, rheumatic fever and bicuspid aortic valve, but its association with other co-morbidities, such as inflammatory disease and race/ethnicity, is less known. AIM To investigate any association between aortic stenosis and many co-morbidities. METHODS We used the large Nationwide Inpatient Sample database to evaluate any association between aortic stenosis and risk factors. We performed univariate and multivariable analyses, adjusting for co-morbid conditions. RESULTS Data were extracted from the first available database that used the International Classification of Diseases, Tenth Revision codes specifically coding for aortic stenosis alone, spanning from 2016 to 2020 (n=112,982,565). A total of 2,322,649 patients had aortic stenosis; the remaining 110,659,916 served as controls. We found a strong and independent significant association between aortic stenosis and coronary artery disease (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 2.09-2.13), smoking (OR: 1.08, 95% CI: 1.07-1.08), diabetes mellitus (OR: 1.15, 95% CI: 1.14-1.16), hypertension (OR: 1.41, 95% CI: 1.4-1.42), hyperlipidaemia (OR: 1.31, 95% CI: 1.3-1.32), renal disease (OR: 1.3, 95% CI: 1.29-1.31), chronic obstructive pulmonary disease (OR: 1.05, 95% CI: 1.04-1.05), obesity (OR: 1.3, 95% CI: 1.29-1.32), white race/ethnicity (OR: 1.47, 95% CI: 1.42-1.52), rheumatoid arthritis (OR: 1.13, 95% CI: 1.11-1.15), scleroderma (OR: 1.93, 95% CI: 1.79-2.09), systemic connective tissue disease (OR: 1.24, 95% CI: 1.2-1.27), polyarteritis nodosa (OR: 1.5, CI: 1.24-1.81) and Raynaud's syndrome (OR: 1.16, 95% CI: 1.09-1.24) (all P<0.001), in addition to known factors, such as age, male sex and bicuspid aortic valve. CONCLUSION Using a very large database, we found many new associations with aortic valve stenosis, including race/ethnicity, renal disease, several inflammatory diseases, chronic obstructive pulmonary disease and obesity, in addition to many other known cardiovascular risk factors.
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Affiliation(s)
- Mohammad Reza Movahed
- University of Arizona College of Medicine, Phoenix, AZ 85724, USA; Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA.
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12
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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: 3] [Impact Index Per Article: 3.0] [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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13
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Farb A, Viviano CJ, Tarver ME. Diversity in Clinical Trial Enrollment and Reporting-Where We Are and the Road Ahead. JAMA Cardiol 2023; 8:803-805. [PMID: 37494022 DOI: 10.1001/jamacardio.2023.2106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Andrew Farb
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Charles J Viviano
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Michelle E Tarver
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
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14
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Ambrosy AP, Go AS, Leong TK, Garcia EA, Chang AJ, Slade JJ, McNulty EJ, Mishell JM, Rassi AN, Ku IA, Lange DC, Philip F, Galper BZ, Berry N, Solomon MD. Temporal trends in the prevalence and severity of aortic stenosis within a contemporary and diverse community-based cohort. Int J Cardiol 2023; 384:107-111. [PMID: 37119944 DOI: 10.1016/j.ijcard.2023.04.047] [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: 02/21/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Data on the epidemiology of aortic stenosis (AS) are primarily derived from single center experiences and administrative claims data that do not delineate by degree of disease severity. METHODS An observational cohort study of adults with echocardiographic AS was conducted January 1st, 2013-December 31st, 2019 at an integrated health system. The presence/grade of AS was based on physician interpretation of echocardiograms. RESULTS A total of 66,992 echocardiogram reports for 37,228 individuals were identified. The mean ± standard deviation (SD) age was 77.5 ± 10.5, 50.5% (N = 18,816) were women, and 67.2% (N = 25,016) were non-Hispanic whites. The age-standardized AS prevalence increased from 589 (95% Confidence Interval [CI] 580-598) to 754 (95% CI 744-764) cases per 100,000 during the study period. The age-standardized AS prevalences were similar in magnitude among non-Hispanic whites (820, 95% CI 806-834), non-Hispanic blacks (728, 95% CI 687-769), and Hispanics (789, 95% CI 759-819) and substantially lower for Asian/Pacific Islanders (511, 95% CI 489-533). Finally, the distribution of AS by degree of severity remained relatively unchanged over time. CONCLUSIONS AND RELEVANCE The population prevalence of AS has grown considerably over a short timeframe although the distribution of AS severity has remained stable.
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Affiliation(s)
- Andrew P Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Thomas K Leong
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Elisha A Garcia
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Alex J Chang
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Justin J Slade
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Edward J McNulty
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Jacob M Mishell
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Andrew N Rassi
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Ivy A Ku
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - David C Lange
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA
| | - Femi Philip
- Department of Cardiology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
| | - Benjamin Z Galper
- Department of Cardiology, Mid-Atlantic Permanente Medical Group, McLean, VA, USA
| | - Natalia Berry
- Department of Cardiology, Mid-Atlantic Permanente Medical Group, McLean, VA, USA
| | - Matthew D Solomon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
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15
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Ilonze O, Free K, Shinnerl A, Lewsey S, Breathett K. Racial, Ethnic, and Gender Disparities in Valvular Heart Failure Management. Heart Fail Clin 2023; 19:379-390. [PMID: 37230651 PMCID: PMC10614031 DOI: 10.1016/j.hfc.2023.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Racial, ethnic, and gender disparities are present in the diagnosis and management of valvular heart disease. The prevalence of valvular heart disease varies by race, ethnicity, and gender, but diagnostic evaluations are not equitable across the groups, which makes the true prevalence less clear. The delivery of evidence-based treatments for valvular heart disease is not equitable. This article focuses on the epidemiology of valvular heart diseases associated with heart failure and the related disparities in treatment, with a focus on how to improve delivery of nonpharmacological and pharmacological treatments.
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Affiliation(s)
- Onyedika Ilonze
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
| | - Kendall Free
- Department of Biofunction Research, Tokyo Medical and Dental University, 2 Chome-3-10 Kanda Surugadai, Chiyoda City, Tokyo 101-0062, Japan
| | - Alexander Shinnerl
- College of Medicine, Indiana University, 340 West 10th Street, Indianapolis, IN 46202, USA
| | - Sabra Lewsey
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 601 North Caroline Street, 7th Floor, Baltimore, MD 21287, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA.
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16
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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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17
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Sivaraj K, Arora S, Hendrickson M, Slehria T, Chang PP, Weickert T, Vaduganathan M, Qamar A, Pandey A, Caughey MC, Cavender MA, Rosamond W, Vavalle JP. Epidemiology and Outcomes of Aortic Stenosis in Acute Decompensated Heart Failure: The ARIC Study. Circ Heart Fail 2023; 16:e009653. [PMID: 36734224 PMCID: PMC10033327 DOI: 10.1161/circheartfailure.122.009653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Few studies characterize the epidemiology and outcomes of aortic stenosis (AS) in acute decompensated heart failure (ADHF). This study investigates the significance of AS in contemporary patients who have experienced an ADHF hospitalization. METHODS The ARIC study (Atherosclerosis Risk in Communities) surveilled ADHF hospitalizations for residents ≥55 years of age in 4 US communities. ADHF cases were stratified by left ventricular ejection fraction (LVEF). Demographic differences in AS burden and the association of varying AS severities with mortality were estimated using multivariable logistic regression. RESULTS From 2005 through 2014, there were 3597 (weighted n=16 692) ADHF hospitalizations of which 48.6% had an LVEF <50% and 51.4% an LVEF ≥50%. AS prevalence was 12.1% and 18.7% in those with an LVEF <50% and ≥50%, respectively. AS was less likely in Black than White patients regardless of LVEF: LVEF <50% (odds ratio [OR], 0.34 [95% CI, 0.28-0.42]); LVEF ≥50% (OR, 0.51 [95% CI, 0.44-0.59]). Higher AS severity was independently associated with 1-year mortality in both LVEF subgroups: LVEF <50% (OR, 1.16 [95% CI, 1.04-1.28]); LVEF ≥50% (OR, 1.40 [95% CI, 1.28-1.54]). Sensitivity analyses excluding severe AS patients detected that mild/moderate AS was independently associated with 1-year mortality in both LVEF subgroups: LVEF <50% (OR, 1.23 [95% CI, 1.02-1.47]); LVEF ≥50% (OR, 1.31 [95% CI, 1.14-1.51]). CONCLUSIONS Among patients who have experienced an ADHF hospitalization, AS is prevalent and portends poor mortality outcomes. Notably, mild/moderate AS is independently associated with 1-year mortality in this high-risk population.
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Affiliation(s)
- Krishan Sivaraj
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Michael Hendrickson
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Trisha Slehria
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Patricia P. Chang
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Thelsa Weickert
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Arman Qamar
- Division of Cardiology, New York University Grossman School of Medicine, New York, New York
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa C. Caughey
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, NC
| | - Matthew A. Cavender
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Wayne Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John P. Vavalle
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC
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Desai K, Slostad B, Twing A, Krishna H, Frazin L, Kansal M. Application of a Novel Two-Dimensional Echocardiographic Calcium Quantification Method to Assess All Severities of Aortic Stenosis. J Am Soc Echocardiogr 2023; 36:69-76. [PMID: 36347388 DOI: 10.1016/j.echo.2022.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Aortic valve (AV) calcification (AVC) is a strong predictor of aortic stenosis (AS) severity. The two-dimensional AVC (2D-AVC) ratio, a gain-independent ratio composed of the average pixel density of the AV and the aortic annulus, has previously shown strong correlations with two-dimensional (2D) echocardiographic hemodynamic parameters for severe AS and AVC by cardiac computed tomography. We hypothesize that the 2D-AVC ratio correlates with hemodynamic parameters in all severities of AS. METHODS A total of 285 patients with a normal AV (n = 49), aortic sclerosis (n = 75), or mild (n = 38), moderate (n = 72), or severe (n = 51) AS undergoing 2D echocardiography were retrospectively evaluated, and the 2D-AVC ratios were correlated to mean AV gradient, peak AV velocity, AV area, and dimensionless index. The 2D-AVC ratios of various AS severities were compared against each other via area under the curve (AUC) analysis. RESULTS The 2D-AVC ratio is strongly correlated with mean AV gradient (r = 0.79, P < .0001) and peak AV velocity (r = 0.78, P < .0001). There was moderate correlation with the AV area (r = -0.58, P < .0001) and dimensionless index (r = -0.67, P < .0001) across all AS severities. The 2D-AVC ratio also distinguished nonmoderate AS (mild AS + normal AV) from moderate or greater (moderate + severe) AS (AUC = 0.93) and moderate versus severe AS (AUC = 0.88). CONCLUSION The 2D-AVC ratio exhibits moderate to strong correlation with 2D echocardiographic hemodynamic parameters across all severities of AS.
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Affiliation(s)
- Kevin Desai
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Brody Slostad
- Department of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Aamir Twing
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Hema Krishna
- Department of Cardiology, University of Illinois at Chicago, Chicago, Illinois; Jesse Brown Veteran Affairs Medical Center, Chicago, Illinois
| | - Leon Frazin
- Department of Cardiology, University of Illinois at Chicago, Chicago, Illinois; Jesse Brown Veteran Affairs Medical Center, Chicago, Illinois
| | - Mayank Kansal
- Department of Cardiology, University of Illinois at Chicago, Chicago, Illinois; Jesse Brown Veteran Affairs Medical Center, Chicago, Illinois.
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19
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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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20
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Crousillat DR, Amponsah DK, Camacho A, Kandanelly RR, Bapat D, Chen C, Selberg A, Shaqdan A, Tanguturi VK, Picard MH, Hung JW, Elmariah S. Racial and Ethnic Differences in the Clinical Diagnosis of Aortic Stenosis. J Am Heart Assoc 2022; 11:e025692. [PMID: 36533618 PMCID: PMC9798798 DOI: 10.1161/jaha.122.025692] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Racial and ethnic minority groups are underrepresented among patients undergoing aortic valve replacement in the United States. We evaluated the impact of race and ethnicity on the diagnosis of aortic stenosis (AS). Methods and Results In patients with transthoracic echocardiography (TTE)-confirmed AS, we assessed rates of AS diagnosis as defined by assignment of an International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) code for AS within a large multicenter electronic health record. Multivariable Cox proportional hazard and competing risk regression models were used to evaluate the 1-year rate of AS diagnosis by race and ethnicity. Among 14 800 patients with AS, the 1-year diagnosis rate for AS following TTE was 37.4%. Increasing AS severity was associated with an increased likelihood of receiving an AS diagnosis (moderate: hazard ratio [HR], 3.05 [95% CI, 2.86-3.25]; P<0.0001; severe: HR, 4.82 [95% CI, 4.41-5.28]; P<0.0001). Compared with non-Hispanic White, non-Hispanic Black (HR, 0.65 [95% CI, 0.54-0.77]; P<0.0001) and non-Hispanic Asian individuals (HR, 0.72 [95% CI, 0.57-0.90], P=0.004) were less likely to receive a diagnosis of AS. Additional factors associated with a decreased likelihood of receiving an AS diagnosis included a noncardiology TTE ordering provider (HR, 0.92 [95% CI, 0.86-0.97]; P=0.005) and TTE performed in the inpatient setting (HR, 0.72 [95% CI, 0.66-0.78]; P<0.0001). Conclusions Rates of receiving an ICD diagnostic code for AS following a diagnostic TTE are low and vary significantly by race and ethnicity and disease severity. Further studies are needed to determine if efforts to maximize the clinical recognition of TTE-confirmed AS may help to mitigate disparities in treatment.
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Affiliation(s)
- Daniela R. Crousillat
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA,Division of Cardiovascular SciencesUniversity of South FloridaTampaFL
| | - Daniel K. Amponsah
- Department of Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Alexander Camacho
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Ritvik R. Kandanelly
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Devavrat Bapat
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Chen Chen
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Alexandra Selberg
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Ayman Shaqdan
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Varsha K. Tanguturi
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Michael H. Picard
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Judy W. Hung
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Sammy Elmariah
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA,Cardiology DivisionUniversity of California San FranciscoSan FranciscoCA
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21
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Yousef S, Amabile A, Ram C, Huang H, Korutla V, Singh S, Agarwal R, Assi R, Milewski RK, Zhang Y, Patel PA, Krane M, Geirsson A, Vallabhajosyula P. Screening Tool to Identify Patients with Advanced Aortic Valve Stenosis. J Clin Med 2022; 11:jcm11154386. [PMID: 35956007 PMCID: PMC9369431 DOI: 10.3390/jcm11154386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/29/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: The clinical burden of aortic stenosis (AS) remains high in Western countries. Yet, there are no screening algorithms for this condition. We developed a risk prediction model to guide targeted screening for patients with AS. (2) Methods: We performed a cross-sectional analysis of all echocardiographic studies performed between 2013 and 2018 at a tertiary academic care center. We included reports of unique patients aged from 40 to 95 years. A logistic regression model was fitted for the risk of moderate and severe AS, with readily available demographics and comorbidity variables. Model performance was assessed by the C-index, and its calibration was judged by a calibration plot. (3) Results: Among the 38,788 reports yielded by inclusion criteria, there were 4200 (10.8%) patients with ≥moderate AS. The multivariable model demonstrated multiple variables to be associated with AS, including age, male gender, Caucasian race, Body Mass Index ≥ 30, and cardiovascular comorbidities and medications. C-statistics of the model was 0.77 and was well calibrated according to the calibration plot. An integer point system was developed to calculate the predicted risk of ≥moderate AS, which ranged from 0.0002 to 0.7711. The lower 20% of risk was approximately 0.15 (corresponds to a score of 252), while the upper 20% of risk was about 0.60 (corresponds to a score of 332 points). (4) Conclusions: We developed a risk prediction model to predict patients' risk of having ≥moderate AS based on demographic and clinical variables from a large population cohort. This tool may guide targeted screening for patients with advanced AS in the general population.
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Affiliation(s)
- Sameh Yousef
- Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06511, USA; (S.Y.); (A.A.); (C.R.); (V.K.); (S.S.); (R.A.); (R.K.M.); (M.K.); (A.G.)
| | - Andrea Amabile
- Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06511, USA; (S.Y.); (A.A.); (C.R.); (V.K.); (S.S.); (R.A.); (R.K.M.); (M.K.); (A.G.)
| | - Chirag Ram
- Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06511, USA; (S.Y.); (A.A.); (C.R.); (V.K.); (S.S.); (R.A.); (R.K.M.); (M.K.); (A.G.)
| | - Huang Huang
- Section of Surgical Outcomes and Epidemiology, Yale School of Public Health, New Haven, CT 06511, USA; (H.H.); (Y.Z.)
| | - Varun Korutla
- Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06511, USA; (S.Y.); (A.A.); (C.R.); (V.K.); (S.S.); (R.A.); (R.K.M.); (M.K.); (A.G.)
| | - Saket Singh
- Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06511, USA; (S.Y.); (A.A.); (C.R.); (V.K.); (S.S.); (R.A.); (R.K.M.); (M.K.); (A.G.)
| | - Ritu Agarwal
- Joint Data Analytics Team, Information Technology Service, Yale University, New Haven, CT 06511, USA;
| | - Roland Assi
- Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06511, USA; (S.Y.); (A.A.); (C.R.); (V.K.); (S.S.); (R.A.); (R.K.M.); (M.K.); (A.G.)
| | - Rita K. Milewski
- Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06511, USA; (S.Y.); (A.A.); (C.R.); (V.K.); (S.S.); (R.A.); (R.K.M.); (M.K.); (A.G.)
| | - Yawei Zhang
- Section of Surgical Outcomes and Epidemiology, Yale School of Public Health, New Haven, CT 06511, USA; (H.H.); (Y.Z.)
| | - Prakash A. Patel
- Division of Cardiac Anesthesiology, Yale School of Medicine, New Haven, CT 06511, USA;
| | - Markus Krane
- Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06511, USA; (S.Y.); (A.A.); (C.R.); (V.K.); (S.S.); (R.A.); (R.K.M.); (M.K.); (A.G.)
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06511, USA; (S.Y.); (A.A.); (C.R.); (V.K.); (S.S.); (R.A.); (R.K.M.); (M.K.); (A.G.)
| | - Prashanth Vallabhajosyula
- Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06511, USA; (S.Y.); (A.A.); (C.R.); (V.K.); (S.S.); (R.A.); (R.K.M.); (M.K.); (A.G.)
- Correspondence: ; Tel.: +1-203-785-6214; Fax: +1-203-785-3346
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Valvular Heart Disease Epidemiology. Med Sci (Basel) 2022; 10:medsci10020032. [PMID: 35736352 PMCID: PMC9228968 DOI: 10.3390/medsci10020032] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Valvular heart disease is a rapidly growing cause of global cardiovascular morbidity and mortality with diverse and evolving geographic distribution. The prevalence of rheumatic heart disease, the most common valvular heart disease (affecting approximately 41 million people), has been rising in developing nations, likely due to the expansion of the young adult population and the decrease in premature mortality that has resulted from improved access to antibiotics, microbiological testing, and echocardiography. Rheumatic heart disease has also been rising among the impoverished and, often, indigenous populations of developed nations, spurring public health initiatives that are aimed at alleviating healthcare disparities. Aortic valve stenotic disease is the most commonly occurring valvular pathology in developed nations (afflicting 9 million people worldwide) and its prevalence has been increasing with population aging and the increased prevalence of atherosclerosis. Aortic regurgitation is associated with diastolic, but not systolic, hypertension and it has likewise seen a rise in the developed world. Mitral regurgitation affects 24 million people worldwide, with great variability between and among nations. Primary mitral regurgitation arises as a consequence of myxomatous degeneration and mitral valve prolapse, which is largely due to genetic predispositions, while secondary mitral regurgitation accounts for 65% of cases and arises secondary to dilation and heart failure. Tricuspid regurgitation has become more prevalent in developed nations due to the increased usage of intracardiac pacemakers. Infective endocarditis prevalence has also grown in developed nations, likely due to population aging and the increased utilization of transcatheter valve replacement and prosthetic valves as interventions against the previously discussed valvular pathologies.
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One and Five-Year Mortality Risk Prediction in Patients with Moderate and Severe Aortic Stenosis. J Clin Med 2022; 11:jcm11102949. [PMID: 35629075 PMCID: PMC9146915 DOI: 10.3390/jcm11102949] [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: 04/04/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Our goal was to develop a risk prediction model for mortality in patients with moderate and severe aortic stenosis (AS). (2) Methods: All patients aged 40−95 years, with echocardiographic evidence of moderate and severe AS at a single institution, were studied over a median of 2.8 (1.5−4.8) years, between 2013−2018. Patient characteristics and mortality were compared using Chi-squares, t-tests, and Kaplan−Meier (KM) curves, as appropriate. The risk calculation for mortality was derived using the Cox proportional hazards model. A risk score was calculated for each parameter, and the total sum of scores predicted the individualized risks of 1-and 5-year mortality. (3) Results: A total of 1991 patients with severe and 2212 with moderate AS were included. Severe AS patients were older, had a lower ejection fraction %, were more likely to be Caucasian, and had lower rates of obesity and smoking, but had higher rates of cardiac comorbidities and AVR (49.3% vs. 2.8%, p < 0.0001). The unadjusted overall mortality was 41.7% vs. 41%, p = 0.6530, and was not different using KM curves (log rank, p = 0.0853). The models included only patients with complete follow-up (3966 in the 1-year, and 816 in the 5-year model) and included 13 variables related to patient characteristics, degree of AS, and AVR. The C-statistic was 0.75 and 0.72 for the 1-year and the 5-year models, respectively. (4) Conclusions: Patients with moderate and severe AS experience high morbidity and mortality. The usage of a risk prediction model may provide guidance for clinical decision making in complex patients.
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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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25
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Kang DY, Ahn JM, Kim JB, Yeung A, Nishi T, Fearon W, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Park SY, Yun SC, Ko E, Park H, Lee SA, Kim DH, Kim HJ, Kim JB, Choo SJ, Park DW, Park SJ. Inter-racial differences in patients undergoing transcatheter aortic valve implantation. Heart 2022; 108:1562-1570. [PMID: 35110384 DOI: 10.1136/heartjnl-2021-320364] [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: 09/23/2021] [Accepted: 01/19/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Little information exists about inter-racial differences in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). We investigated whether differences in baseline characteristics between Asian and non-Asian population may contribute to disparities in clinical outcomes after TAVI. METHODS We performed a registry-based, multinational cohort study of patients with severe AS who underwent TAVI at two centres in the USA and one centre in South Korea. The primary outcome was a composite of death, stroke or rehospitalisation at 1 year. RESULTS Of 1412 patients, 581 patients were Asian and 831 were non-Asian (87.5% white, 1.7% black, 6.1% Hispanic or 4.7% others). There were substantial differences in baseline characteristics between two racial groups. The primary composite outcome was significantly lower in the Asian group than in the non-Asian group (26.0% vs 35.0%; HR 0.73; 95% CI 0.59 to 0.89; p=0.003). However, after adjustment of baseline covariates, the risk of primary composite outcome was not significantly different (HR 0.79; 95% CI 0.60 to 1.03; p=0.08). The all-cause mortality at 1 year was significantly lower in the Asian group than the non-Asian group (7.4% vs 12.5%; HR 0.60; 95% CI 0.41 to 0.88; p=0.009). After multivariable adjustment, the risk of all-cause mortality was also similar (HR 1.17; 95% CI 0.73 to 1.88; p=0.52). CONCLUSIONS There were significant differences in baseline and procedural factors among Asian and non-Asian patients who underwent TAVI. Observed inter-racial differences in clinical outcomes were largely explained by baseline differences in clinical, anatomical and procedural factors. TRIAL REGISTRATION NUMBER NCT03826264 (https://wwwclinicaltrialsgov).
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Affiliation(s)
- Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan Yeung
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William Fearon
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric Page Cantey
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James D Flaherty
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Seo Young Park
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Euihong Ko
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hanbit Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Jin Kim
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suk Jung Choo
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Lamprea-Montealegre JA, Oyetunji S, Bagur R, Otto CM. Valvular Heart Disease in Relation to Race and Ethnicity: JACC Focus Seminar 4/9. J Am Coll Cardiol 2021; 78:2493-2504. [PMID: 34886971 DOI: 10.1016/j.jacc.2021.04.109] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/06/2021] [Indexed: 12/28/2022]
Abstract
Valvular heart disease (VHD) is a major global public health problem. Many regions of the world continue to grapple with the adverse consequences of untreated rheumatic heart disease, a condition that is largely preventable with timely access to diagnosis and treatment. In turn, middle- and high-income countries have experienced a rise in the prevalence of calcific aortic and mitral disease, owing in part to population aging. This public health problem is further compounded by high rates of infective endocarditis, which is associated with substantial morbidity and mortality. Yet, considerations of race and ethnicity have not taken center stage in VHD research. This is despite evidence of major health care disparities in socioeconomic and medical risk factors, access to diagnosis, and provision of appropriate treatment. In this paper, the authors review differences in the etiology, diagnosis, and treatment of VHD within the context of race, ethnicity, and health care disparities.
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Affiliation(s)
- Julio A Lamprea-Montealegre
- Division of Cardiology and Kidney Health Research Collaborative, University of California-San Francisco, San Francisco, California, USA
| | - Shakirat Oyetunji
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington, USA
| | - Rodrigo Bagur
- Division of Cardiology, Western University, London, Ontario, Canada
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, Washington, USA.
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27
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Ott C, Pappritz K, Hegemann N, John C, Jeuthe S, McAlpine CS, Iwamoto Y, Lauryn JH, Klages J, Klopfleisch R, Van Linthout S, Swirski F, Nahrendorf M, Kintscher U, Grune T, Kuebler WM, Grune J. Spontaneous Degenerative Aortic Valve Disease in New Zealand Obese Mice. J Am Heart Assoc 2021; 10:e023131. [PMID: 34779224 PMCID: PMC9075397 DOI: 10.1161/jaha.121.023131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Degenerative aortic valve (AoV) disease and resulting aortic stenosis are major clinical health problems. Murine models of valve disease are rare, resulting in a translational knowledge gap on underlying mechanisms, functional consequences, and potential therapies. Naïve New Zealand obese (NZO) mice were recently found to have a dramatic decline of left ventricular (LV) function at early age. Therefore, we aimed to identify the underlying cause of reduced LV function in NZO mice. Methods and Results Cardiac function and pulmonary hemodynamics of NZO and age-matched C57BL/6J mice were monitored by serial echocardiographic examinations. AoVs in NZO mice demonstrated extensive thickening, asymmetric aortic leaflet formation, and cartilaginous transformation of the valvular stroma. Doppler echocardiography of the aorta revealed increased peak velocity profiles, holodiastolic flow reversal, and dilatation of the ascending aorta, consistent with aortic stenosis and regurgitation. Compensated LV hypertrophy deteriorated to decompensated LV failure and remodeling, as indicated by increased LV mass, interstitial fibrosis, and inflammatory cell infiltration. Elevated LV pressures in NZO mice were associated with lung congestion and cor pulmonale, evident as right ventricular dilatation, decreased right ventricular function, and increased mean right ventricular systolic pressure, indicative for the development of pulmonary hypertension and ultimately right ventricular failure. Conclusions NZO mice demonstrate as a novel murine model to spontaneously develop degenerative AoV disease, aortic stenosis, and the associated end organ damages of both ventricles and the lung. Closely mimicking the clinical scenario of degenerative AoV disease, the model may facilitate a better mechanistic understanding and testing of novel treatment strategies in degenerative AoV disease.
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Affiliation(s)
- Christiane Ott
- Department of Molecular Toxicology German Institute of Human Nutrition Potsdam-Rehbruecke Germany.,German Centre for Cardiovascular Research (partner site Berlin) Berlin Germany
| | - Kathleen Pappritz
- German Centre for Cardiovascular Research (partner site Berlin) Berlin Germany.,Berlin Institute of Health Center for Regenerative Therapies and Berlin-Brandenburg Center for Regenerative Therapies Charité-Universitätsmedizin BerlinCampus Virchow Klinikum Berlin Germany
| | - Niklas Hegemann
- German Centre for Cardiovascular Research (partner site Berlin) Berlin Germany.,Institute of Physiology Charité-Universitätsmedizin Berlin Berlin Germany
| | - Cathleen John
- Department of Molecular Toxicology German Institute of Human Nutrition Potsdam-Rehbruecke Germany.,German Centre for Cardiovascular Research (partner site Berlin) Berlin Germany
| | - Sarah Jeuthe
- German Centre for Cardiovascular Research (partner site Berlin) Berlin Germany.,Department of Medicine/Cardiology Deutsches Herzzentrum Berlin Berlin Germany.,Max-Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany
| | - Cameron S McAlpine
- Center for Systems Biology Massachusetts General Hospital and Harvard Medical School Boston MA
| | - Yoshiko Iwamoto
- Center for Systems Biology Massachusetts General Hospital and Harvard Medical School Boston MA
| | - Jonathan H Lauryn
- German Centre for Cardiovascular Research (partner site Berlin) Berlin Germany.,Institute of Physiology Charité-Universitätsmedizin Berlin Berlin Germany
| | - Jan Klages
- Department of Anesthesiology Deutsches Herzzentrum Berlin Berlin Germany
| | - Robert Klopfleisch
- Department of Veterinary Pathology Freie Universität Berlin Berlin Germany
| | - Sophie Van Linthout
- German Centre for Cardiovascular Research (partner site Berlin) Berlin Germany.,Berlin Institute of Health Center for Regenerative Therapies and Berlin-Brandenburg Center for Regenerative Therapies Charité-Universitätsmedizin BerlinCampus Virchow Klinikum Berlin Germany.,Department of Cardiology Charité-Universitätsmedizin BerlinCampus Virchow Klinikum Berlin Germany
| | - Fil Swirski
- Center for Systems Biology Massachusetts General Hospital and Harvard Medical School Boston MA
| | - Matthias Nahrendorf
- Center for Systems Biology Massachusetts General Hospital and Harvard Medical School Boston MA
| | - Ulrich Kintscher
- German Centre for Cardiovascular Research (partner site Berlin) Berlin Germany.,Center for Cardiovascular Research/Institute of Pharmacology Charité-Universitätsmedizin Berlin Berlin Germany
| | - Tilman Grune
- Department of Molecular Toxicology German Institute of Human Nutrition Potsdam-Rehbruecke Germany.,German Centre for Cardiovascular Research (partner site Berlin) Berlin Germany.,German Center for Diabetes Research München-Neuherberg Germany.,Institute of Nutritional Science University of Potsdam Nuthetal Germany
| | - Wolfgang M Kuebler
- German Centre for Cardiovascular Research (partner site Berlin) Berlin Germany.,Institute of Physiology Charité-Universitätsmedizin Berlin Berlin Germany.,Departments of Surgery and Physiology University of Toronto and Keenan Research Centre for Biomedical Science of St. Michael's Toronto Canada
| | - Jana Grune
- German Centre for Cardiovascular Research (partner site Berlin) Berlin Germany.,Institute of Physiology Charité-Universitätsmedizin Berlin Berlin Germany.,Center for Systems Biology Massachusetts General Hospital and Harvard Medical School Boston MA.,Center for Cardiovascular Research/Institute of Pharmacology Charité-Universitätsmedizin Berlin Berlin Germany
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Lee CH, Inohara T, Hayashida K, Park DW. Transcatheter Aortic Valve Replacement in Asia: Present Status and Future Perspectives. JACC. ASIA 2021; 1:279-293. [PMID: 36341218 PMCID: PMC9627874 DOI: 10.1016/j.jacasi.2021.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/01/2021] [Accepted: 10/07/2021] [Indexed: 05/28/2023]
Abstract
Over the last decade, based on evidence from multiple randomized clinical trials, transcatheter aortic valve replacement (TAVR) has become the established treatment for patients with symptomatic severe aortic stenosis. Despite the overwhelming expansion of TAVR in Western countries, the initial uptake and widespread adoption of this procedure have been relatively delayed in Asian countries, owing to the high cost of devices; limited local health and reimbursement policies; and lack of specific training/proctoring program, specialized heart team, or dedicated infrastructure. Furthermore, it has not yet been determined whether there are substantial interracial and ethnic differences in the clinical characteristics, comorbidities, and anatomic features, as well as procedural and long-term outcomes, in patients receiving TAVR. In this review, we provide not only a comprehensive look at the current status and outcomes of TAVR in Asian populations compared with those of Western populations but also a perspective on the future of TAVR in Asia.
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Key Words
- AR, aortic regurgitation
- AS, aortic stenosis
- BAV, bicuspid aortic valve
- BSA, body surface area
- PPI, permanent pacemaker insertion
- PPM, patient-prosthesis mismatch
- PVL, paravalvular leak
- RCT, randomized clinical trial
- SAVR, surgical aortic valve replacement
- STS, Society of Thoracic Surgeons
- TAVR, transcatheter aortic valve replacement
- VHD, valvular heart disease
- aortic stenosis
- outcomes
- race and ethnicity
- valvular disease
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Affiliation(s)
- Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Deagu, South Korea
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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29
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Lian Q, Wang J, Lian Y, Yang Q, Zhao M, Zhang Y. Impact of valvular heart disease on hip replacement: a retrospective nationwide inpatient sample database study. BMC Musculoskelet Disord 2021; 22:860. [PMID: 34627205 PMCID: PMC8501620 DOI: 10.1186/s12891-021-04738-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To study the impact of valvular heart disease (VHD) on hip replacement, particularly the clinical impactions of aortic stenosis before total/partial hip arthroplasty. METHODS This was a retrospective cohort study. Data on patients who had undergone hip replacement from 2005 to 2014 were extracted from the NIS database. Independent t test and chi-square test were used to analyze the essential characteristics of patients. Multivariate regression was used to estimate the correlation among demographics, comorbidities, complications, hospitalization costs, and time. RESULTS VHD accounted for 5.56% and AS accounted for 0.03% of the patients before hip replacement surgeries. Patients with VHD before hip replacement are related to the following characteristics: female patients (odds ratio [OR] = 1.15 [1.12-1.18]), elective admission (OR = 0.78 [0.76-0.80]), Charlson Comorbidity Index ≥3 (OR = 1.06 [1.03-1.08]), large-volume hospitals (OR = 1.13 [1.1-1.2]), teaching hospitals (OR = 5 4.4 [2.9-6.7]), and hospital location in urban areas (OR = 1.22 [1.2-1.3]). In addition, VHD is a risk factor for mortality and some acute postoperative medical complications, such as acute cardiac event (OR = 2.96 [2.87-3.04]), acute pulmonary edema (OR = 1.13 [1.06-1.21]), acute cerebrovascular event (OR = 1.22 [1.16-1.74]), and acute renal failure (OR = 1.22 [1.17-1.27]). It also has an impact on DVT/PE (OR = 0.89 [0.8-0.99]). Patients with AS before hip replacement have basic demographic characteristics like those of hip replacement patients with valvular disease. Patients with AS are older than those without AS before surgery (OR = 3.28 [2.27-4.75) and are related to the following characteristics: female patients (OR = 1.92 [1.32-2.8]) and elective admission (OR = 0.51 [0.36-0.75]). The perioperative period is limited to acute postoperative complications, such as acute cardiac events (OR = 2.50 [1.76-3.53]) and acute hepatic failure (OR = 7.69 [1.8-32.89]). Both valvular diseases and AS are associated with a higher mortality rate and hospitalization cost. CONCLUSION VHD independently predicted mortality rate and surgical and medical complications after total/partial hip arthroplasty.
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Affiliation(s)
- Qiang Lian
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Yun Lian
- First Affiliation Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Mingchen Zhao
- Goodwill Hessian Health Technology Co., Ltd., Beijing, 100007, China
| | - Yang Zhang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
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30
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Brennan JM, Lowenstern A, Sheridan P, Boero IJ, Thourani VH, Vemulapalli S, Wang TY, Liska O, Gander S, Jager J, Leon MB, Peterson ED. Association Between Patient Survival and Clinician Variability in Treatment Rates for Aortic Valve Stenosis. J Am Heart Assoc 2021; 10:e020490. [PMID: 34387116 PMCID: PMC8475044 DOI: 10.1161/jaha.120.020490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with symptomatic severe aortic stenosis (ssAS) have a high mortality risk and compromised quality of life. Surgical/transcatheter aortic valve replacement (AVR) is a Class I recommendation, but it is unclear if this recommendation is uniformly applied. We determined the impact of managing cardiologists on the likelihood of ssAS treatment. Methods and Results Using natural language processing of Optum electronic health records, we identified 26 438 patients with newly diagnosed ssAS (2011-2016). Multilevel, multivariable Fine-Gray competing risk models clustered by cardiologists were used to determine the impact of cardiologists on the likelihood of 1-year AVR treatment. Within 1 year of diagnosis, 35.6% of patients with ssAS received an AVR; however, rates varied widely among managing cardiologists (0%, lowest quartile; 100%, highest quartile [median, 29.6%; 25th-75th percentiles, 13.3%-47.0%]). The odds of receiving AVR varied >2-fold depending on the cardiologist (median odds ratio for AVR, 2.25; 95% CI, 2.14-2.36). Compared with patients with ssAS of cardiologists with the highest treatment rates, those treated by cardiologists with the lowest AVR rates experienced significantly higher 1-year mortality (lowest quartile, adjusted hazard ratio, 1.22, 95% CI, 1.13-1.33). Conclusions Overall AVR rates for ssAS were low, highlighting a potential challenge for ssAS management in the United States. Cardiologist AVR use varied substantially; patients treated by cardiologists with lower AVR rates had higher mortality rates than those treated by cardiologists with higher AVR rates.
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Affiliation(s)
- J Matthew Brennan
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Angela Lowenstern
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Paige Sheridan
- Department of Family Medicine and Public Health University of California, San Diego School of Medicine San Diego CA.,Boston Consulting Group Boston MA
| | | | - Vinod H Thourani
- Department of Cardiovascular Surgery Piedmont Heart Institute Atlanta GA
| | | | - Tracy Y Wang
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | | | | | | | - Martin B Leon
- Columbia University Irving Medical Center and New York Presbyterian Hospital New York NY
| | - Eric D Peterson
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
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31
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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: 13] [Impact Index Per Article: 4.3] [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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Erinne I, Sethi A, Johannesen J, Kassotis J. Racial disparities in the treatment of aortic stenosis: Has transcatheter aortic valve replacement bridged the gap? Catheter Cardiovasc Interv 2021; 98:148-156. [PMID: 33527675 DOI: 10.1002/ccd.29487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/14/2020] [Accepted: 01/08/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Racial disparities in outcomes and utilization of surgical aortic valve replacement (SAVR) for the treatment of severe aortic stenosis (AS) is well known. While transcatheter aortic valve replacement (TAVR) has become more widespread, its impact on racial disparities remains unclear. OBJECTIVES Our goal was to assess the utilization of SAVR and TAVR and their clinical outcomes among various racial groups. METHODS The National Inpatient database (2009-2015) was used to study the racial distribution of admissions for SAVR and TAVR, and their impact on inpatient outcomes. Survey estimation commands were used to determine weighted national estimates. RESULTS There were 3,445,267; 294,108; and 52,913 inpatient visits for AS, SAVR, and TAVR, respectively. SAVR visits were 86% White, 3.8% Black, 5.5% Hispanic, 1.2% Asian/Pacific Islander (A/PI), 0.4% Native American (NA), and 2.9%; TAVR were 87.7% White, 3.7% Black, 3.8% Hispanic, 1.0% A/PI, 0.2% NA, and 3.5% Other while AS visits were 83.7% White, 6.7% Black, 5.3% Hispanic, 1.7% A/PI, 0.4% NA, and 2.2% Other. Racial minorities generally had more co-morbidities compared with Whites. After SAVR, Black patients had a higher unadjusted inpatient mortality than Whites, however, there was no difference after adjustment for other variables. A/PI were more likely to require a permanent pacemaker after SAVR. Need for blood transfusion was significantly higher among the minorities compared with Whites, except for NA, but there were no racial differences in stroke rates. There was no difference in inpatient mortality, pacemaker implantation, stroke, and bleeding after TAVR, but acute kidney injury occurred more often in Hispanics, A/PI, and "others" compared with Whites. CONCLUSIONS Racial disparities in the treatment of AS continues in the contemporary era; however it was found that TAVR resulted in comparable inpatient outcomes, despite higher comorbidities, and adverse socioeconomic factors in minorities.
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Affiliation(s)
- Ikenna Erinne
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ankur Sethi
- Department of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Justin Johannesen
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - John Kassotis
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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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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Kebed K, Sun D, Addetia K, Mor-Avi V, Markuzon N, Lang RM. Progression of aortic stenosis and echocardiographic criteria for its severity. Eur Heart J Cardiovasc Imaging 2021; 21:737-743. [PMID: 32335667 DOI: 10.1093/ehjci/jeaa075] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/20/2020] [Accepted: 03/27/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS Guidelines-recommended criteria for identifying severe aortic stenosis (AS) are based on small, homogenous cohorts of patients, leading to potentially inconsistent or missed diagnosis. We used a large cohort of patients with varying degrees of AS to (i) characterize its progression; (ii) evaluate the influence of demographic and echocardiographic variables; and (iii) derive haemodynamically consistent cut-off values. METHODS AND RESULTS We identified 916 patients with mild to severe AS who had undergone >1 echocardiographic study (N = 2547). For each study, aortic valve area (AVA), peak transaortic velocity (Vmax), and mean pressure gradient (ΔP) were extracted. Annual rates of AVA change were determined by a linear mixed-effects model. To determine the prevalence of inconsistent diagnosis of severe AS, AVA was plotted against ΔP and Vmax, with quadrants defined using guidelines-recommended cut-offs. The rate of AVA change was -0.070 ± 0.003 cm2/year and was more rapid in men than women and in Whites than African Americans. AVA = 1 cm2 corresponded to ΔP = 32 mmHg and Vmax = 3.7 m/s, causing discrepancies in defining severe AS in 480 (19%) and 458 (18%) studies, respectively. Conversely, ΔP = 40 mmHg corresponded to AVA = 0.89 cm2 and Vmax = 4.0 m/s corresponded to AVA = 0.92 cm2, confirming the inconsistency of the guidelines. Notably, discrepancy rate was higher in 206 patients with low flow (SVi < 35 mL/m2): 40% vs. 16% in the remaining patients. CONCLUSION Our findings demonstrated gender- and race-related differences in AS progression and underscored the need to refine the multiparametric criteria for diagnosis of severe AS to minimize internal inconsistencies, which are high with the current cut-offs and amplified in patients with low stroke volumes.
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Affiliation(s)
- Kalie Kebed
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | - Deyu Sun
- Philips Healthcare, Cambridge, MA, USA
| | - Karima Addetia
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | | | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5509, Chicago, IL 60637, USA
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von Kappelgaard L, Gislason G, Davidsen M, Zwisler AD, Juel K. Temporal trends and socioeconomic differences in treatment and mortality following a diagnosis of aortic stenosis. Int J Cardiol 2021; 336:87-92. [PMID: 34051288 DOI: 10.1016/j.ijcard.2021.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
AIMS This study aims at determining the temporal trends and the socioeconomic differences in treatment and mortality following a diagnosis of aortic stenosis. METHODS AND RESULTS A total of 45,026 patients with a first-time diagnosis of aortic stenosis were identified in the Danish National Patient Registry in the period 2000-17. The risk of AVR within the first year after diagnosis decreased (OR = 1.84 in 2000-02 compared to 2015-16) and the risk was lower in the low-level educational group (OR = 0.85) and in the medium-level group (OR = 0.94) compared to high-level education. The risk of death after AVR within the first year decreased (OR = 2.25 in 2000-02 compared to 2015-16) and the risk was higher in the low-level educational group (OR = 1.32) and in the medium-level group (OR = 1.28) compared to high-level education. The risk of death within the first year after diagnosis, for those patients who did not get an AVR during the follow-up, decreased (OR = 3.08 in 2000-02 compared to 2015-16) and the risk was higher in the low-level educational group (OR = 1.21) and in the medium-level group (OR = 1.10) compared to high-level education. CONCLUSION Since 2000 there has been a decrease in both AVR treatment rate, mortality rate after AVR and mortality rate in patients not receiving AVR. For patients with lower-level education there is lower AVR treatment rate, higher mortality rate after AVR and higher mortality rate in patients not receiving AVR.
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Affiliation(s)
- Lene von Kappelgaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte University Hospitals, Gentofte, Denmark.
| | - Gunnar Gislason
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte University Hospitals, Gentofte, Denmark
| | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ann-Dorthe Zwisler
- The National Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Yankey GS, Jackson LR, Marts C, Chiswell K, Wu A, Ugowe F, Wilson J, Vemulapalli S, Samad Z, Thomas KL. African American-Caucasian American differences in aortic valve replacement in patients with severe aortic stenosis. Am Heart J 2021; 234:111-121. [PMID: 33453161 PMCID: PMC9899489 DOI: 10.1016/j.ahj.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Among patients with severe aortic stenosis (AS), there are limited data on aortic valve replacement (AVR), reasons for nonreceipt and mortality by race. METHODS Utilizing the Duke Echocardiography Laboratory Database, we analyzed data from 110,711 patients who underwent echocardiography at Duke University Medical Center between 1999 and 2013. We identified 1,111 patients with severe AS who met ≥1 of 3 criteria for AVR: ejection fraction ≤50%, diagnosis of heart failure, or need for coronary artery bypass surgery. Logistic regression models were used to assess the association between race, AVR and 1-year mortality. χ2 testing was used to assess potential racial differences in reasons for AVR nonreceipt. RESULTS Among the 1,111 patients (143 AA and 968 CA) eligible for AVR, AA were more often women, had more diabetes, renal insufficiency, aortic regurgitation and left ventricular hypertrophy. CA were more often smokers, had more ischemic heart disease, hyperlipidemia and higher median income levels. There were no racial differences in surgical risk utilizing logistic euroSCORES. Relative to CA, AA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) yet similar 1-year mortality (aHR 0.81, 95% CI 0.57-1.17, P = .262). There were no significant differences in reasons for AVR nonreceipt. CONCLUSIONS We identified 143 African Americans (AA) and 968 Caucasian Americans(CA) with severe AS who met prespecified criteria for AVR.. AA relative to CA were more often women, had more diabetes, renal insufficiency, and left ventricular hypertrophy, however had less tobacco use, ischemic heart disease, hyperlipidemia and lower median income levels. Among patients with severe AS, AA relative to CA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) without significant differences in reasons for AVR nonreceipt and similar 1-year mortality.
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Affiliation(s)
| | - Larry R Jackson
- Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Colin Marts
- Duke University School of Medicine, Durham, NC
| | | | - Angie Wu
- Duke Clinical Research Institute, Durham, NC
| | | | | | - Sreekanth Vemulapalli
- Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - Kevin L Thomas
- Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC.
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Fleury MA, Clavel MA. Sex and Race Differences in the Pathophysiology, Diagnosis, Treatment, and Outcomes of Valvular Heart Diseases. Can J Cardiol 2021; 37:980-991. [PMID: 33581193 DOI: 10.1016/j.cjca.2021.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 12/22/2022] Open
Abstract
Valvular heart diseases have long been considered to be similar in men and women and across races/ethnicities. Recently, studies have demonstrated major differences between sexes. Unfortunately, studies on valvular heart diseases, as on other cardiovascular diseases, are mostly performed in Caucasian men or in cohorts with a vast majority of Caucasian men. Therefore, our knowledge on valvular diseases in women and non-Caucasians remains limited. Nevertheless, aortic stenosis has been shown to be almost as prevalent in women as in men, and less prevalent in African Americans. Men appear to have a more calcified aortic valve lesion, and women tend to have a more fibrosed one. Primary mitral regurgitation is more frequent in women who have more rheumatic and Barlow etiologies, whereas men have more fibroelastic deficiency and posterior leaflet prolapse/flail. Left ventricular remodelling due to valvular heart diseases is sex related in terms of geometry and probably also in composition of the tissue. Outcomes seem to be worse in women after surgical interventions and better than or equivalent to men after transcatheter ones. Regarding other valvular heart diseases, very few studies are available: Aortic regurgitation is more frequent in men, isolated tricuspid regurgitation more frequent in women. Rheumatic valve diseases are more frequent in women and are mostly represented by mitral and aortic stenoses. Many other sex/gender- and race/ethnic-specific studies are still needed in epidemiology, pathophysiology, presentation, management, and outcomes. This review aims to report the available data on sex differences and race specificities in valvular heart diseases, with a primary focus on aortic stenosis and mitral regurgitation.
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Affiliation(s)
- Marie-Ange Fleury
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
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Grave C, Juillière Y, Tuppin P, Weill A, Gabet A, Tribouilloy C, Olié V. Epidemiological Features of Aortic Stenosis in a French Nationwide Study: 10-Year Trends and New Challenges. J Am Heart Assoc 2020; 9:e017588. [PMID: 33222585 PMCID: PMC7763773 DOI: 10.1161/jaha.120.017588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Aortic stenosis (AS) is one of the most common forms of valvular heart disease. Our aim was to estimate the burden of AS in the hospital in France, describe patient characteristics, and evaluate the mortality rate and temporal trends. Methods and Results All patients hospitalized for AS in France between 2006 and 2016 were identified from the national hospital discharge database. Patients’ sociodemographic, medical, and surgical characteristics and temporal trends were described. All AS‐related deaths between 2000 and 2014 were identified using death certificates. In 2016, 26 071 patients were hospitalized for AS: 56.5% were men with an average age of 77 years. The all‐cause mortality rate at 1 year postindex stay was 11%. The rate of patients hospitalized for AS increased by 59% between 2006 and 2016, reaching 38.7/100 000 person‐years in 2016. This increase was most pronounced in patients aged >75 years. The number of transcatheter aortic valve implantations increased following their introduction in 2010. In 2016, 44% of patients were treated with aortic valve surgery during the index hospital stay or following year (mean age, 71.5 years), and 34% were treated with transcatheter aortic valve implantation (mean age, 83.0 years). In 2014, 6186 deaths caused by AS were identified in death certificates: 41.6% were men with an average age of 87 years. The age‐standardized mortality rate increased by 5% between 2000 and 2014, reaching 8.5/100 000 person‐years in 2014. Conclusions The rate of patients hospitalized for AS increased in recent years in line with the higher life expectancy and introduction of transcatheter aortic valve implantation. Mortality increased more moderately.
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Affiliation(s)
- Clémence Grave
- Santé Publique France French Public Health Agency Saint-Maurice France
| | - Yves Juillière
- Department of Cardiology Nancy University Hospital Vandoeuvre-lès-Nancy France
| | - Philippe Tuppin
- Caisse Nationale de l'Assurance Maladie French National Health Insurance Paris Cedex 20 France
| | - Alain Weill
- Caisse Nationale de l'Assurance Maladie French National Health Insurance Paris Cedex 20 France
| | - Amélie Gabet
- Santé Publique France French Public Health Agency Saint-Maurice France
| | | | - Valérie Olié
- Santé Publique France French Public Health Agency Saint-Maurice France
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Khan SU, Kalra A, Kapadia SR, Khan MU, Zia Khan M, Khan MS, Mamas MA, Warraich HJ, Nasir K, Michos ED, Alkhouli M. Demographic, Regional, and State-Level Trends of Mortality in Patients With Aortic Stenosis in United States, 2008 to 2018. J Am Heart Assoc 2020; 9:e017433. [PMID: 33070675 PMCID: PMC7763421 DOI: 10.1161/jaha.120.017433] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/21/2020] [Indexed: 01/08/2023]
Abstract
Background Aortic stenosis-related mortality might vary across demographic subsets, regions, and states in the United States. Methods and Results We reviewed the death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research database to examine aortic stenosis-related mortality trends from 2008 to 2018. Crude and age-adjusted mortality rates (AAMRs) per 100 000 people and annual percentage change with 95% CIs were calculated. Between 2008 and 2018, AAMR reduced from 12.7 to 11.5 (average annual percentage change, -1.0 [95% CI, -1.5 to -0.5]), because of an accelerated decline between 2015 and 2018 (annual percentage change, -4.4 [95% CI, -6.0 to -2.7]). Older (aged >85 years), male, and White patients had higher death rates than younger, female, and non-White patients, respectively. Although mortality reduction was similar across sexes, significant mortality reduction was limited to White patients only. The AAMRs were higher in rural than urban areas. States with AAMRs >90th percentile were distributed in the West and the Northeast, and <10th percentile in the South. The AAMRs for sex and race were highest in the West and lowest in the South. None of the states located in the Midwest showed a significant reduction in mortality. Mortality remained stable for hospital setting and nursing home/long-term care facility, except that the number of deaths increased at home and hospice facility since 2014. Conclusions The reduction in mortality in patients with aortic stenosis was not consistent among demographic subsets and states. The substantial public health and economic implications call for determination of underlying clinical and socioeconomic factors to narrow the gap.
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Affiliation(s)
- Safi U. Khan
- Department of MedicineWest Virginia UniversityMorgantownWV
| | - Ankur Kalra
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
- Section of Cardiovascular ResearchHeart, Vascular and Thoracic DepartmentCleveland Clinic Akron GeneralAkronOH
| | - Samir R. Kapadia
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | | | | | | | - Mamas A. Mamas
- Keele Cardiovascular Research GroupKeele UniversityStoke‐on‐TrentUK
- Department of MedicineJefferson UniversityPhiladelphiaPA
| | | | - Khurram Nasir
- Department of Cardiovascular MedicineHouston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | - Erin D. Michos
- Division of CardiologyDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMD
- The Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins School of MedicineBaltimoreMD
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Lee DC, Liang H, Chen N, Shi L, Liu Y. Cancer screening among racial/ethnic groups in health centers. Int J Equity Health 2020; 19:43. [PMID: 32216800 PMCID: PMC7099813 DOI: 10.1186/s12939-020-1153-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Underserved and low-income population are placed at a disadvantage for receiving necessary cancer screenings. This study aims to measure the rates of receiving three types of cancer screening services, Pap test, mammogram and colorectal cancer screening, among patients seen at U.S. health centers (HCs) to investigate if cancer screening among patients varies by race/ethnicity. Methods We analyzed data from the 2014 U.S. Health Center Patient Survey, and included samples age 21 and above. We examined three cancer screening indicators as our dependent variables including cervical, breast, and colorectal cancer screening. Logistic regressions were used to assess the racial/ethnic disparities on cancer screening, while controlling for potentially confounding factors. Results The rates of receiving three types of cancer screening were comparable and even higher among HC patients than those for the U.S. general population. Both bivariate and multivariate results showed there were racial/ethnic differences in the likelihood of receiving cancer screening services. However, the differences did not favor non-Hispanic Whites. African Americans had higher odds than Whites (OR: 1.92, 95% CI: 1.44–2.55, p < 0.001) of receiving Pap tests. Similar results were also found in measures of the receipt of mammogram (OR = 1.96, 95% CI: 1.46–2.64, P < 0.001) and colorectal cancer screening (OR = 1.28, 95% CI: 1.02–1.60, p < 0.05). Conclusion The current study presents U.S. nationally representative estimates and imply that HCs are helping fulfill an important role as a health care safety-net in reducing racial/ethnic disparities in the delivery of cancer screening services.
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Affiliation(s)
- De-Chih Lee
- Department of Information Management, Da-Yeh University, No.168, University Rd., Dacun, Changhua, 51591, Taiwan, R.O.C.,Johns Hopkins Primary Care Policy Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Hailun Liang
- Johns Hopkins Primary Care Policy Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.,Renmin University of China, School of Public Administration and Policy, Beijing, China
| | - Nanqian Chen
- Renmin University of China, School of Public Administration and Policy, Beijing, China
| | - Leiyu Shi
- Johns Hopkins Primary Care Policy Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Ying Liu
- Renmin University of China, School of Public Administration and Policy, Beijing, China.
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Wilson JB, Jackson LR, Ugowe FE, Jones T, Yankey GS, Marts C, Thomas KL. Racial and Ethnic Differences in Treatment and Outcomes of Severe Aortic Stenosis. JACC Cardiovasc Interv 2020; 13:149-156. [DOI: 10.1016/j.jcin.2019.08.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/19/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
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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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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: 26] [Impact Index Per Article: 5.2] [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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Tzizik D. Approaches to Valvular Heart Disease in the Primary Care Setting. PHYSICIAN ASSISTANT CLINICS 2017. [DOI: 10.1016/j.cpha.2017.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liang H, Zhu J, Kong X, Beydoun MA, Wenzel JA, Shi L. The Patient-Centered Care and Receipt of Preventive Services Among Older Adults With Chronic Diseases: A Nationwide Cross-sectional Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2017; 54:46958017724003. [PMID: 28814174 PMCID: PMC5798736 DOI: 10.1177/0046958017724003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article investigates the associations between the patient-centered care (PCC) and receipt of preventive services among older adults with chronic diseases. Data were derived from the nationally representative Medical Expenditure Panel Survey. The full-year consolidated data files from 2009 to 2013 were pooled to yield a final analytic sample (N = 16 654). Study outcomes included the receipt of 7 types of preventive screenings and 2 types of health education services. Patients’ PCC groups were categorized as PCC, partial PCC, and non-PCC, based on 9 questions classified under the 3 distinctive attributes of PCC—whole-person care, patient engagement, and enhanced access to care. Prevalence rates for each outcome variable were calculated. We estimated odds ratios from multiple logistic regressions, comparing the likelihood of outcome variables across 3 groups of patients. Adjusting for covariates, the PCC group was more likely than the non-PCC group to receive 8 types of preventive services. The partial PCC group had a greater likelihood than the non-PCC group of receiving 7 types of preventive services. Our study reveals significant associations between PCC and receipt of preventive services. PCC has demonstrated the potential to improve preventive care for older adults with chronic diseases.
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Affiliation(s)
| | - Junya Zhu
- 1 Johns Hopkins University, Baltimore, MD, USA
| | | | - May A Beydoun
- 2 National Institute on Aging, Intramural Research Program, NIH, Baltimore, MD, USA
| | | | - Leiyu Shi
- 1 Johns Hopkins University, Baltimore, MD, USA
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Cruz Rodriguez B, Acharya P, Salazar-Fields C, Horne A. Comparison of Frequency of Referral to Cardiothoracic Surgery for Aortic Valve Disease in Blacks, Hispanics, and Whites. Am J Cardiol 2017; 120:450-455. [PMID: 28583680 DOI: 10.1016/j.amjcard.2017.04.048] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 11/24/2022]
Abstract
Racial differences in prevalence and in intervention rate of those with severe aortic stenosis have been reported. Our objective was to evaluate health disparities in referral to cardiothoracic surgery (CTS) for aortic stenosis in black and Hispanic compared with white patients before the transcatheter aortic valve replacement program was started in our community. Using a retrospective cohort design, we identified all patients >40 years, who had been captured with aortic valve disease from January 2011 to June 2016. Clinical and echocardiographic data were collected manually. Exposure was race/ethnicity; outcome was referral to CTS. Multivariable logistic regression analysis was conducted with variables that had significance of p <0.20 in univariate model. We included 952 patients in the final analysis (423 white, 376 black, and 153 Hispanic). Compared with whites, black subjects were significantly younger, had more advanced degrees of kidney disease, were more likely to have Medicaid as payer, and had more atherogenic co-morbidities. Black patients had significantly higher aortic valve area indexed for body surface area, more aortic regurgitation, lower peak velocities, lower transvalvular gradients, less calcified valves, and fewer patients in aortic stenosis stage D. The adjusted odds ratio for CTS referral was 0.48 for blacks (p <0.001) and 0.86 for Hispanics (p = 0.73) compared with whites. In conclusion, after adjusting for clinical and echocardiographic variables, black patients were less likely to be referred to CTS for treatment of aortic valve disease. We found no difference in the referral pattern of Hispanic compared with white patients.
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