Racial, ethnic and socioeconomic disparities in patients undergoing left atrial appendage closure

Sparrow, Robbie; Sanjoy, Shubrandu; Choi, Yun Hee; Elgendy, Islam Y.; Jneid, Hani; Villablanca, Pedro A.; Holmes, David R.; Pershad, Ashish; Alraies, Chadi; Sposato, Luciano A.; Mamas, Mamas A.; Bagur, Rodrigo

doi:10.1136/heartjnl-2020-318650

Cited by 21 publications

(16 citation statements)

References 25 publications

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“…As previously shown in both mitral TEER (8,9) and non-mitral TEER populations (5,6), our findings demonstrated a discrepancy between racial segmentation of the general public and that of an interventional cardiology cohort, which further expanded as patients aged. While non-white individuals comprised 22.1% of patients who underwent mitral TEER at our institution between 2013 and 2020, their percentage among those aged ≥65 or ≥ 75 years was 18.7% or 15.3%, respectively.…”

Section: Discussionsupporting

confidence: 73%

“…Consequently, it has a central role in the management of these conditions according to the most recent North American (3) and European (4) practice guidelines. Lately, there has been increased recognition of the interaction between race/ethnicity and numerous disease states and therapies, including percutaneous structural heart interventions (5,6). While not explicitly assessed in the pivotal randomized controlled trials, racial disparities affecting the mitral TEER arena were found in real-world reports that examined shortterm, namely in-hospital, outcomes (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

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Racial disparities in characteristics and outcomes of patients undergoing mitral transcatheter edge-to-edge repair

Shechter

Kaewkes

Makar

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThere are scarce data regarding the post-mitral transcatheter edge-to-edger repair (TEER) course in different racial groups.ObjectiveTo assess the impact of race on outcomes following TEER for mitral regurgitation (MR).MethodsThis is a single-center, retrospective analysis of consecutive TEER procedures performed during 2013–2020. The primary outcome was the composite of all-cause mortality or heart failure (HF) hospitalizations along the first postprocedural year. Secondary outcomes included individual components of the primary outcome, New York Heart Association (NYHA) class, MR grade, and left ventricular mass index (LVMi).ResultsOut of 964 cases, 751 (77.9%), 88 (9.1%), 68 (7.1%), and 57 (5.9%) were whites, blacks, Asians, and Hispanics, respectively. At baseline, non-whites and blacks were younger and more likely be female, based in lower socioeconomic areas, not fully insured, diagnosed with functional MR, and affected by biventricular dysfunction. Intra-procedurally, more devices were implanted in blacks. At 1-year, non-whites (vs. whites) and blacks (vs. non-blacks or whites) experienced higher cumulative incidence of the primary outcome (32.9% vs. 22.5%, p = 0.002 and 38.6% vs. 23.4% or 22.5%, p = 0.002 or p = 0.001, respectively), which were accounted for by hospitalizations in the functional MR sub-cohort (n = 494). NYHA class improved less among blacks with functional MR. MR severity and LVMi equally regressed in all groups. White race (HR 0.62, 95% CI 0.39–0.99, p = 0.047) and black race (HR 2.07, 95% CI 1.28–3.35, p = 0.003) were independently associated with the primary outcome in functional MR patients only.ConclusionMitral TEER patients of different racial backgrounds exhibit major differences in baseline characteristics. Among those with functional MR, non-whites and blacks also experience a less favorable 1-year clinical outcome.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Racial disparities in characteristics and outcomes of patients undergoing mitral transcatheter edge-to-edge repair

Shechter

Kaewkes

Makar

et al. 2023

Front. Cardiovasc. Med.

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“…Three studies using NIS data on hospitalization for LAAO procedure reported underrepresentation, greater complication rate, longer hospital stay and higher discharge complexity in the non-White population receiving LAAO compared with White patients. 67,68,69 Lower socioeconomic status was not associated with a higher complication rate. 67,68,69 In another analysis using the same NIS data, only 12.4% of non-White patients were reported to have undergone the LAAO procedure in the United States.…”

Section: Left Atrial Appendage Occlusion (Laao)mentioning

confidence: 92%

“…67,68,69 Lower socioeconomic status was not associated with a higher complication rate. 67,68,69 In another analysis using the same NIS data, only 12.4% of non-White patients were reported to have undergone the LAAO procedure in the United States. 70 Higher odds of mortality and other adverse outcomes were reported in one study among non-White patients undergoing LAAO procedure compared with White patients.…”

Section: Left Atrial Appendage Occlusion (Laao)mentioning

confidence: 92%

Racial and Ethnic Differences in the Management of Atrial Fibrillation

et al. 2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Studies have shown that among individuals ≥80 years of age, >80% of this population present with multiple comorbid conditions, and comorbidity burden is a strong predictor of poor outcomes. 14 , 15 , 19 , 20 , 21 , 22 , 23 One potential explanation for the differences in CCI and ECS (lower CCI in patients ≥80 years old while higher ECS as compared with <80 years old) would be the fact that the CCI captures about half the number of comorbidities than the ECS and, therefore, the differences in P values are likely driven by the difference in sample sizes.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Elderly Patients Undergoing Left Atrial Appendage Closure

Sanjoy

Choi

Sparrow

et al. 2021

JAHA

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Background Elderly patients have a higher burden of comorbidities that influence clinical outcomes. We aimed to compare in‐hospital outcomes in patients ≥80 years old to younger patients, and to determine the factors associated with increased risk of major adverse events (MAE) after left atrial appendage closure. Methods and Results The National Inpatient Sample was used to identify discharges after left atrial appendage closure between October 2015 and December 2018. The primary outcome was in‐hospital MAE defined as the composite of postprocedural bleeding, vascular and cardiac complications, acute kidney injury, stroke, and death. A total of 6779 hospitalizations were identified, of which, 2371 (35%) were ≥80 years old and 4408 (65%) were <80 years old. Patients ≥80 years old experienced a higher rate of MAE compared with those aged <80 years old (6.0% versus 4.6%, P =0.01), and this difference was driven by a numerically higher rate of cardiac complications (2.4% versus 1.8%, P =0.09) and death (0.3% versus 0.1%, P =0.05) among individuals ≥80 years old. In patients ≥80 years old, higher odds of in‐hospital MAE were observed in women (1.61‐fold), and those with preprocedural congestive heart failure (≈2‐fold), diabetes (≈1.5‐fold), renal disease (≈2.6‐fold), anemia (≈2.7‐fold), and dementia (≈5‐fold). In patients <80 years old, a higher risk of in‐hospital MAE was encountered among women (≈1.4‐fold) and those with diabetes (≈1.3‐fold), renal disease (≈2.6‐fold), anemia (≈2‐fold), and dyslipidemia (≈1.2‐fold). Conclusions Patients ≥80 years old had higher rates of in‐hospital MAE compared with patients aged <80 years old. Female sex and the presence of heart failure, diabetes, renal disease, and anemia were factors associated with in‐hospital MAE among both groups.

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Racial, ethnic and socioeconomic disparities in patients undergoing left atrial appendage closure

Cited by 21 publications

References 25 publications

Racial disparities in characteristics and outcomes of patients undergoing mitral transcatheter edge-to-edge repair

Racial disparities in characteristics and outcomes of patients undergoing mitral transcatheter edge-to-edge repair

Racial and Ethnic Differences in the Management of Atrial Fibrillation

Outcomes of Elderly Patients Undergoing Left Atrial Appendage Closure

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