Racial Disparities in the Utilization and Outcomes of TAVR

• DOI: 10.1016/j.jcin.2019.03.007
• Publication Date: 2019-05-20T19:40:20Z
• Authors: Mohamad Alkhouli; David R. Holmes; John D. Carroll; Zhuokai Li; Taku Inohara; Andrzej S. Kosinski; Molly Szerlip; Vinod H. Thourani; Michael J. Mack; Sreekanth Vemulap...
• Keywords: Aged, 80 and over; Male; Time Factors; Racial Groups; Hemodynamics; Aortic Valve Stenosis; Recovery of Function; Medicare; Risk Assessment; Race Factors; 3. Good health; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Risk Factors; Aortic Valve; Humans; Female; Hospital Mortality; Registries; Healthcare Disparities; Practice Patterns, Physicians'; Aged

This study sought to evaluate racial disparities in the performance and outcomes of transcatheter aortic valve replacement (TAVR).Racial disparities in cardiovascular diseases are well described. Whether the racial disparities observed in surgical aortic valve replacement also exist with TAVR remains unknown.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.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.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.