Racial Disparities in the Utilization and Outcomes of TAVR: TVT Registry Report

Mohamad Alkhouli, David R. Holmes, John D. Carroll, Zhuokai Li, Taku Inohara, Andrzej S. Kosinski, Molly Szerlip, Vinod H. Thourani, Michael J. Mack, Sreekanth Vemulapalli

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Objectives: This study sought to evaluate racial disparities in the performance and outcomes of transcatheter aortic valve replacement (TAVR). Background: Racial disparities in cardiovascular diseases are well described. Whether the racial disparities observed in surgical aortic valve replacement also exist with TAVR remains unknown. Methods: Patients undergoing TAVR between November 2011 and June 2016 were identified in the American College of Cardiology/Society of Thoracic Surgeons/Transcatheter Valve Therapy Registry. We described the racial distribution, and the risk-adjusted in-hospital morbidity, and mortality stratified by race. We evaluated 1-year outcomes in a subset of patients via linkage to Medicare (Centers for Medicare and Medicaid Services) claims. Results: Among the 70,221 included patients, 91.3% were white, 3.8% were black, 3.4% were Hispanic, and 1.5% were of Asian/Native American/Pacific Islander race. This represented significant underrepresentation of nonwhite patients compared with their proportion of the population. After risk-adjustment, there was no difference in the rates of in-hospital mortality, myocardial infarction, stroke, major bleeding, vascular complications, or new pacemaker requirements among the 4 racial groups. Among 29,351 patients with Centers for Medicare and Medicaid Services linkage, 1-year adjusted mortality rates were similar in blacks and Hispanics compared with whites, but lower among patients of Asian/Native American/Pacific Islander race (adjusted hazard ratio: 0.71; 95% confidence interval: 0.55 to 0.92; p = 0.028). Black and Hispanic patients had more heart failure hospitalizations compared with whites (adjusted hazard ratio: 1.39; 95% confidence interval: 1.16 to 1.67; p < 0.001; and adjusted hazard ratio: 1.37; 95% confidence interval: 1.13 to 1.66; p = 0.004, respectively). These differences persisted after additional risk-adjustment for socioeconomic status. Conclusions: Racial minorities are underrepresented among patients undergoing TAVR in the United States, but their adjusted 30-day and 1-year clinical outcomes are comparable with those of white race.

Original languageEnglish (US)
Pages (from-to)936-948
Number of pages13
JournalJACC: Cardiovascular Interventions
Volume12
Issue number10
DOIs
StatePublished - May 27 2019

Keywords

  • aortic stenosis
  • racial disparity
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Racial Disparities in the Utilization and Outcomes of TAVR: TVT Registry Report'. Together they form a unique fingerprint.

  • Cite this

    Alkhouli, M., Holmes, D. R., Carroll, J. D., Li, Z., Inohara, T., Kosinski, A. S., Szerlip, M., Thourani, V. H., Mack, M. J., & Vemulapalli, S. (2019). Racial Disparities in the Utilization and Outcomes of TAVR: TVT Registry Report. JACC: Cardiovascular Interventions, 12(10), 936-948. https://doi.org/10.1016/j.jcin.2019.03.007