Racial and Ethnic Disparities in the Use and Outcomes of Transcatheter Mitral Valve Replacement: Analysis From the National Inpatient Sample Database

Ismayl, Mahmoud; Abbasi, Muhannad Aboud; Al-abcha, Abdullah; El-Am, Edward; Walters, Ryan W.; Goldsweig, Andrew M.; Alkhouli, Mohamad; Guerrero, Mayra; Anavekar, Nandan S.

doi:10.1161/jaha.122.028999

Cited by 14 publications

(5 citation statements)

References 28 publications

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“…Studies have found that Black patients are less likely to undergo mitral valvuloplasty, especially when their disease is non-rheumatic in origin [ 13 ]. Hispanic are also less likely to receive mitral valve interventions, specifically Transcatheter Mitral Valve Replacement (TMVR), an important technique for patients at high open surgical risk [ 25 ]. Transcatheter Edge to Edge Repair (TEER) is a similarly important technique for high-risk patients.…”

Section: Literature Review and Resultsmentioning

confidence: 99%

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Disparities in Mitral Valve Disease Associated with Heart Failure

Foley,

Hammond,

et al. 2024

Rev. Cardiovasc. Med.

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Heart failure (HF) affects millions of people around the world and is a prevalent health issue in the United States. In many cases, HF has an intricate connection with mitral valvular disease (MVD), which can alter a patient’s disease course. Factors such as gender, race, ethnicity, and social determinants of health impact the prevalence, etiology, and treatment of MVD associated with HF. This literature review examines the connection between MVD and HF among adult patients, considering MVD as both a cause and an outcome of HF. This article also identifies the differences in epidemiology and treatment of MVD associated with HF across different gender, ethnicity, race, and socioeconomic groups. This is in an effort to not only identify currently overlooked disparities but to highlight potential ways to improve them. MVD was analyzed based on its hemodynamic subtypes, mitral regurgitation (MR) and mitral stenosis (MS), as these subtypes encompass different etiologies of MVD. The purpose of this article was to identify broad disparities in MVD in association with HF in the adult population. The results of this study found stark differences between prevalence, treatment, and disease outcomes across groups. Women and Black patients were identified as high-risk for under-utilization and prescription delay of treatment options. Women were often treated at more advanced stages of MVD, while treatment was often delayed in Black patient populations. Factors such as these impact treatment outcomes. Conversely, men and White patients were identified as lower-risk groups for treatment inadequacies and poor HF and MVD related outcomes. Socioeconomic status (SES) was also found to play a role, with low SES being a risk factor for developing rheumatic heart disease. Low SES groups are also more likely to develop HF, which predisposes to secondary MR. Despite general knowledge of these disparities, few studies analyze HF and MVD for specific groups. This literature review is thus necessary to identify current inequities in care and underscore potential solutions to raise awareness for further research efforts and funding. This analysis identifies MVD treatment guidelines and contributing social determinants of health as areas that must be addressed to minimize HF and MVD disparities.

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Section: Literature Review and Resultsmentioning

confidence: 99%

“…[ 4 , 5 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 19 ]) and Table 2 (Ref. [ 12 , 13 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]) below.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Mitral Valve Disease Associated with Heart Failure

Foley,

Hammond,

et al. 2024

Rev. Cardiovasc. Med.

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“…14 Similar to prior NIS studies, three racial/ethnic groups with small sample sizes (Asian or Pacific Islander, Native American, and other) were combined into a single ‘other’ group to facilitate the analysis. 15–17 The other three HCUP racial/ethnic groups (White, Black, and Hispanic) were left unchanged for the study. The ‘White’ group refers to non-Hispanic White patients, the ‘Black’ group refers to non-Hispanic Black patients, and the ‘Hispanic’ group refers to Hispanic patients of all races and origins.…”

Section: Methodsmentioning

confidence: 99%

In-hospital safety outcomes of left atrial appendage occlusion in octogenarians and nonagenarians

Ismayl,

Ahmed,

Goldsweig

et al. 2024

Europace

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Background and Aims Data on safety outcomes of left atrial appendage occlusion (LAAO) in elderly patients are limited. This study aimed to compare the outcomes of LAAO between octogenarians (age 80-89) and nonagenarians (age ≥90) versus younger patients (age ≤79). Methods We conducted a retrospective cohort study using the National Inpatient Sample database to identify patients hospitalized for LAAO from 2016-2020 and to compare in-hospital safety outcomes in octogenarians and nonagenarians versus younger patients. The primary outcome was a composite of in-hospital all-cause mortality or stroke. Secondary outcomes included procedural complications, length of stay (LOS), and total costs. Outcomes were determined using logistic regression models. Results Among 84,140 patients hospitalized for LAAO, 32.9% were octogenarians, 2.8% were nonagenarians, and 64.3% were ≤79 years of age. Over the study period, the volume of LAAO increased in all age groups (all ptrend<0.01). After adjustment for clinical and demographic factors, octogenarians and nonagenarians had similar odds of in-hospital all-cause mortality or stroke (adjusted odds ratio [aOR] 1.41, 95% confidence interval [CI] 0.93-2.13 for octogenarians; aOR 1.69, 95% CI 0.67-3.92 for nonagenarians), cardiac tamponade, acute kidney injury, major bleeding, and blood transfusion, in addition to similar LOS and total costs compared with younger patients (all p>0.05). However, octogenarians and nonagenarians had higher odds of vascular complications (aOR 1.47, 95% CI 1.08-1.99 for octogenarians; aOR 1.60, 95% CI 1.18-2.97 for nonagenarians). Conclusion Octogenarians and nonagenarians undergoing LAAO have a similar safety profile compared with clinically similar younger patients except for a higher rate of vascular complications.

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“…15 This method was similar to other studies analyzing racial and ethnic disparities among different disease processes and their treatments. 17 , 18 , 19 , 20 , 21 , 22 …”

Section: Methodsmentioning

confidence: 99%

Racial and Ethnic Disparities in Treatment of Critical Limb Ischemia: A National Perspective

Wahood,

Duval,

Takahashi

et al. 2023

JAHA

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Background Recent guidelines have emphasized the use of medical management, early diagnosis, and a multidisciplinary team to effectively treat patients with critical limb ischemia (CLI). Previous literature briefly highlighted the current racial disparities in its intervention. Herein, we analyze the trend over a 14‐year time period to investigate whether the disparities gap in CLI management is closing. Methods and Results The National Inpatient Sample was queried between 2005 and 2018 for hospitalizations involving CLI. Nontraumatic amputations and revascularization were identified. Utilization trends of these procedures were compared between races (White, Black, Hispanic, Asian and Pacific Islander, Native American, and Other). Multivariable regression assessed differences in race regarding procedure usage. There were 6 904 562 admissions involving CLI in the 14‐year study period. The rate of admissions in White patients who received any revascularization decreased by 0.23% ( P <0.001) and decreased by 0.25% ( P =0.025) for Asian and Pacific Islander patients. Among all patients, the annual rate of admission in White patients who received any amputation increased by 0.21% ( P <0.001), increased by 0.19% ( P =0.001) for Hispanic patients, and increased by 0.19% ( P =0.012) for the Other race patients. Admissions involving Black, Hispanic, Asian and Pacific Islander, or Other race patients had higher odds of receiving any revascularization compared with White patients. All races had higher odds of receiving major amputation compared with White patients. Conclusions Our analysis highlights disparities in CLI treatment in our nationally representative sample. Non‐White patients are more likely to receive invasive treatments, including major amputations and revascularization for CLI, compared with White patients.

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Racial and Ethnic Disparities in the Use and Outcomes of Transcatheter Mitral Valve Replacement: Analysis From the National Inpatient Sample Database

Cited by 14 publications

References 28 publications

Disparities in Mitral Valve Disease Associated with Heart Failure

Disparities in Mitral Valve Disease Associated with Heart Failure

In-hospital safety outcomes of left atrial appendage occlusion in octogenarians and nonagenarians

Racial and Ethnic Disparities in Treatment of Critical Limb Ischemia: A National Perspective

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