Racial Disparities in the Utilization and Outcomes of TAVR: TVT Registry Report.
- 2019
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. 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. Copyright (c) 2019. Published by Elsevier Inc. 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. OBJECTIVES: This study sought to evaluate racial disparities in the performance and outcomes of transcatheter aortic valve replacement (TAVR). 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.
English
1936-8798
*Aortic Valve Stenosis/su [Surgery] *Aortic Valve/su [Surgery] *Continental Population Groups *Healthcare Disparities/eh [Ethnology] *Practice Patterns, Physicians' *Transcatheter Aortic Valve Replacement Aged Aged, 80 and over Aortic Valve Stenosis/eh [Ethnology] Aortic Valve Stenosis/mo [Mortality] Aortic Valve Stenosis/pp [Physiopathology] Aortic Valve/pp [Physiopathology] Female Hemodynamics Hospital Mortality/eh [Ethnology] Humans Male Medicare Postoperative Complications/eh [Ethnology] Postoperative Complications/mo [Mortality] Postoperative Complications/th [Therapy] Race Factors Recovery of Function Registries Risk Assessment Risk Factors Time Factors Transcatheter Aortic Valve Replacement/ae [Adverse Effects] Transcatheter Aortic Valve Replacement/mo [Mortality] Trauma Severity Indices Treatment Outcome United States/ep [Epidemiology]