TY - JOUR
T1 - Racial Disparities in the Utilization and Outcomes of TAVR
T2 - TVT Registry Report
AU - Alkhouli, Mohamad
AU - Holmes, David R.
AU - Carroll, John D.
AU - Li, Zhuokai
AU - Inohara, Taku
AU - Kosinski, Andrzej S.
AU - Szerlip, Molly
AU - Thourani, Vinod H.
AU - Mack, Michael J.
AU - Vemulapalli, Sreekanth
N1 - Funding Information:
Funded by the Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapies Registry. Dr. Carroll is an investigator in clinical trial for Edwards and Medtronic. Dr. Inohara has received a research grant from JSPS Overseas Research fellowship and Boston Scientific. Dr. Szerlip has consulted for Edwards and Medtronic. Dr. Mack is a Co-PI of Partner trial of Edwards Lifesciences, Co-PI of Coapt trial of Abbott, and study chair of Apollo trial of Medtronic. Dr. Vemulapalli received a research grant from Abbott Vascular and a research grant, consulting fees, and is an advisory board member for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2019
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/5/27
Y1 - 2019/5/27
N2 - 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.
AB - 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.
KW - aortic stenosis
KW - racial disparity
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85065451514&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85065451514&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2019.03.007
DO - 10.1016/j.jcin.2019.03.007
M3 - Article
C2 - 31122351
AN - SCOPUS:85065451514
VL - 12
SP - 936
EP - 948
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 10
ER -