Effect of Race on the Incidence of Aortic Stenosis and Outcomes of Aortic Valve Replacement in the United States

Alqahtani, Fahad; Aljohani, Sami; Amin, Ali Hama; Al-Hijji, ‪Mohammed; Ali, Oluseun O.; Holmes, David R.; Alkhouli, Mohamad

doi:10.1016/j.mayocp.2017.11.026

Cited by 40 publications

(41 citation statements)

References 23 publications

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“…That said, there was no significant difference in aortic valve repairs/replacements in our study, and the aortic valve is the second most common valve affected by IE [18]. In another study using the NIS that compared aortic valve replacements in Black and White patients who presented with aortic stenosis, researchers found that Blacks were less likely to undergo surgery, as suggested by Alqahtani and Patel [9,19]. One potential reason the authors concluded for this finding was that Black patients are less likely to have severe aortic stenosis in general [19].…”

Section: Discussionmentioning

confidence: 41%

“…Additionally, valvular repairs/replacements are often indicated for patients who fail to respond appropriately to antimicrobials or develop significant complications from IE. However, prior studies have shown that Black patients receive less aortic and mitral valve repairs compared to White patients when such procedures are indicated [9,10]. Thus, determining if differences exist for in-hospital mortality and surgical interventions in older patients with IE by race is crucial to understanding potential aspects of care that need improvement.…”

Section: Introductionmentioning

confidence: 99%

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The influence of race in older adults with infective endocarditis

et al. 2020

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Background: Age is a risk factor for infective endocarditis, and almost half of diagnosed patients are age ≥ 60 years. Large national studies have not evaluated inpatient mortality and surgical valvular interventions between older White and Black patients hospitalized with infective endocarditis. Methods: We used the Nationwide Inpatient Sample database to identify older adults ≥60 years in North America with a principle diagnosis of infective endocarditis. Multivariate logistic regression was used to compare in-hospital mortality and valvular repairs/replacement between older Black and White patients. Results: Of 10,390 adults, age ≥ 60 years hospitalized for infective endocarditis during 2013 and 2014, 7356 were White and 1089 Black. Blacks were younger (mean age: 70.5 ± 0.5 vs. 73.5 ± 0.2 years, p < 0.01), lived in more zip codes with a median annual income <$39,000/yr. (40.4% vs 18.8%, p < 0.01), and had higher co-morbidity burden (Charlson comorbidity score ≥ 3: 54.6% vs 40.7%, p < 0.01). After multivariate adjustment, Blacks had higher odds for in-hospital mortality (Odds Ratio (OR) = 2.0, [Confidence Interval (CI) 1.1-3.8]; p = 0.020), and lower odds for mitral valve repairs/replacements (OR = 0.53, CI: 0.29-0.99, p = 0.049). Conclusions: Blacks age ≥ 60 years hospitalized in North America with infective endocarditis are less likely to undergo mitral valvular repairs/replacement and had higher in-hospital mortality compared to White patients.

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Section: Discussionmentioning

confidence: 41%

Section: Introductionmentioning

confidence: 99%

The influence of race in older adults with infective endocarditis

et al. 2020

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“…However, this could be due to some genetic difference in the occurrence of NRVHD, with less risk in blacks. Evidence to support this comes from the USA, where African Americans compared to Caucasians are at significantly lower risk of developing severe aortic stenosis due to degenerative calcific disease or congenitally bicuspid valve disease [82], as well as degenerative mitral valve disease presenting for surgery [83].…”

Section: Non-rheumatic Valvular Heart Diseasementioning

confidence: 99%

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

et al. 2020

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Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests that SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations. Highlights:-The burden of non-communicable diseases including cardiovascular diseases is rising in SSA.-Levels of hypertension diagnosis, treatment, and control are low at <40%, <35%, and 10-20%, respectively, and more than 40% of patients with diabetes are not aware of their diagnosis in SSA. -SSA has 23% of the world's prevalent rheumatic heart disease cases.-The leading causes of heart failure in SSA are hypertensive heart disease, cardiomyopathy, and rheumatic heart disease, with ischemic heart disease accounting for <10% of cases compared to >50% in high-income countries.

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“…Although ethnicity, insurance status, income, and other socioeconomic factors were not discussed in the article by Zaouter et al, 1 racial and socioeconomic inequalities are welldocumented in the cardiac surgery literature. 5,6 Among valve surgery patients, African Americans tend to have longer and more costly hospital stays 7 and more frequent complications than their white counterparts. 8,9 Uninsured and Medicaid status, as markers of low socioeconomic position, are associated with increased postoperative mortality.…”

Section: Enhanced Recovery After Surgery Protocols May Help Reduce Ramentioning

confidence: 99%

Enhanced Recovery After Surgery Protocols May Help Reduce Racial and Socioeconomic Disparities in Cardiac Surgery

Hoyler

White

Tam

2020

Journal of Cardiothoracic and Vascular Anesthesia

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Effect of Race on the Incidence of Aortic Stenosis and Outcomes of Aortic Valve Replacement in the United States

Cited by 40 publications

References 23 publications

The influence of race in older adults with infective endocarditis

The influence of race in older adults with infective endocarditis

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

Enhanced Recovery After Surgery Protocols May Help Reduce Racial and Socioeconomic Disparities in Cardiac Surgery

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