Racial/Ethnic Disparities in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights from the Healthcare Cost and Utilization Project's National Inpatient Sample

Hernández-Suárez, Dagmar F.; Ranka, Sagar; Villablanca, Pedro A.; Yordan-Lopez, Nicole; González-Sepúlveda, Lorena; Wiley, Jose; Sanina, Cristina; Roche-Lima, Abiel; Nieves-Rodriguez, Brenda G.; Thomas, S.V.; Cox‐Alomar, Pedro; López‐Candales, Angel; Ramakrishna, Harish

doi:10.1016/j.carrev.2019.04.005

Cited by 28 publications

(22 citation statements)

References 24 publications

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“…Black race was an independent predictor of PPM (52.9%) in our study, with significantly higher prevalence compared with other ethnicities . Our study findings contradict those of study using the Nationwide Inpatient Sample database that found no significant difference of TAVR outcomes between African American and Caucasian patients . However, Herrmann et al identified non‐white/race as a predictor of PPM, similar to our study.…”

Section: Discussioncontrasting

confidence: 57%

Predictors and outcomes of patient‐prosthesis mismatch after transcatheter aortic valve replacement

et al. 2019

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Background: Patient-prosthesis mismatch (PPM) has been shown to be associated with adverse outcomes after surgical aortic valve replacement. There is limited data on its risk and impact after transcatheter aortic valve replacement (TAVR), especially with the newer generation heart valves.Objectives: The objective of this study is to investigate the incidence, predictors, and clinical outcomes of PPM after TAVR.Methods: This is a retrospective study of 991 consecutive patients who underwent TAVR procedure at a tertiary referral center, between April 2012 and February 2019. Patients were stratified by the presence or absence of PPM, defined as an effective orifice area/body surface area ratio ≤0.85 cm 2 /m 2 . Multivariable logistic regression analysis was used to determine independent predictors of PPM. Kaplan-Meier survival estimates were used to determine overall 5-year survival.Results: PPM was encountered in 27.6% of patients. In multivariable analysis, age less than 70 years (P = .062), body mass index (BMI) more than 30 (P = .0057), history of atrial fibrillation (P = .0004), black race (P = .0078), and Sapien 3 sizes 20 and 23 mm (P < .0001)emerged as independent predictors of PPM. Sapien 3 valve size 20/23 mm was associated with higher risk of PPM compared to other valve types. Patients with PPM had comparable postoperative outcomes and overall 5-year survival. There was no significant difference in postoperative complications between patient groups. PPM was not associated with worse overall survival (56% for both PPM and no-PPM patients, log-rank P = .80).Conclusions: Younger age, atrial fibrillation, black race, higher BMI were predictors of PPM. Smaller sizes balloon-expandable valves had a higher risk of PPM. K E Y W O R D S aortic stenosis, cardiac surgery, patient-prosthesis mismatch, TAVR Abbreviations: TAVR, transcatheter aortic valve replacement; SAVR, surgical aortic valve replacement; PPM, patient-prosthesis mismatch; BMI, body mass index.

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Section: Discussioncontrasting

confidence: 57%

Predictors and outcomes of patient‐prosthesis mismatch after transcatheter aortic valve replacement

et al. 2019

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“…• Efforts to revise existing standards or to redesign paediatric medication labels and dosing tools should be specifically tailored to meet the needs of limited literacy and LEP individuals. Hernandez-Suarez et al [ 48 ] 2019 US Hospital Setting National Inpatient Sample (NIS) database files n = 36,270 Caucasians, African Americans and Hispanics. a) To identify racial/ethnic disparities in utilization rates, in-hospital outcomes and health care resource use among Non-Hispanic Whites (NHW), African Americans (AA) and Hispanics undergoing TAVR • Hispanic patients had higher in-hospital complications.…”

Section: Resultsmentioning

confidence: 99%

“…The nature and severity of adverse events and disparity in the occurrence of these events was examined in thirteen studies, primary emerging from the US. Differences between ethnic minority patients and others in safety events were predominantly examined using large administrative datasets, retrospective record reviews and systematic reviews focused on rates of (i) hospital acquired infections (HAIs), (ii) complications in care and (iii) adverse drug events (ADEs) [ 15 , 35 , 37 , 39 , 48 , 56 – 59 , 62 , 66 , 69 , 71 ].…”

Section: Resultsmentioning

confidence: 99%

The safety of health care for ethnic minority patients: a systematic review

Chauhan

Walton

Manias

et al. 2020

Int J Equity Health

150

157

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Introduction: Evidence to date indicates that patients from ethnic minority backgrounds may experience disparity in the quality and safety of health care they receive due to a range of socio-cultural factors. Although heightened risk of patient safety events is of key concern, there is a dearth of evidence regarding the nature and rate of patient safety events occurring amongst ethnic minority consumers, which is critical for the development of relevant intervention approaches to enhance the safety of their care. Objectives: To establish how ethnic minority populations are conceptualised in the international literature, and the implications of this in shaping of our findings; the evidence of patient safety events arising among ethnic minority healthcare consumers internationally; and the individual, service and system factors that contribute to unsafe care. Method: A systematic review of five databases (MEDLINE, PUBMED, PsycINFO, EMBASE and CINAHL) were undertaken using subject headings (MeSH) and keywords to identify studies relevant to our objectives. Inclusion criteria were applied independently by two researchers. A narrative synthesis was undertaken due to heterogeneity of the study designs of included studies followed by a study appraisal process. Results: Forty-five studies were included in this review. Findings indicate that: (1) those from ethnic minority backgrounds were conceptualised variably; (2) people from ethnic minority backgrounds had higher rates of hospital acquired infections, complications, adverse drug events and dosing errors when compared to the wider population; and (3) factors including language proficiency, beliefs about illness and treatment, formal and informal interpreter use, consumer engagement, and interactions with health professionals contributed to increased risk of safety events amongst these populations. Conclusion: Ethnic minority consumers may experience inequity in the safety of care and be at higher risk of patient safety events. Health services and systems must consider the individual, inter-and intra-ethnic variations in the nature of safety events to understand the where and how to invest resource to enhance equity in the safety of care. Review registration: This systematic review is registered with Research Registry: reviewregistry761.

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“…The majority of large studies have used the National Inpatient Sample, which does not allow linkage of multiple hospital admissions for the same patient. 22 , 23 , 24 As a result, studies of racial inequities in TAVR using National Inpatient Sample data are limited by the use of admissions rather than patients as the denominator and therefore cannot accurately estimate AS prevalence nor TAVR or SAVR incidence on a per‐patient basis. Studies using other data are limited by very small sample sizes.…”

mentioning

confidence: 99%

Inequities in Aortic Stenosis and Aortic Valve Replacement Between Black/African‐American, White, and Hispanic Residents of Maryland

Czarny

Hasan

Post

et al. 2021

JAHA

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Background Racial and ethnic inequities exist in surgical aortic valve replacement for aortic stenosis (AS), and early studies have suggested similar inequities in transcatheter aortic valve replacement. Methods and Results We performed a retrospective analysis of the Maryland Health Services Cost Review Commission inpatient data set from 2016 to 2018. Black patients had half the incidence of any inpatient AS diagnosis compared with White patients (incidence rate ratio [IRR], 0.50; 95% CI, 0.48–0.52; P <0.001) and Hispanic patients had one fourth the incidence compared with White patients (IRR, 0.25; 95% CI, 0.22–0.29; P <0.001). Conversely, the incidence of any inpatient mitral regurgitation diagnosis did not differ between White and Black patients (IRR, 1.00; 95% CI, 0.97–1.03; P =0.97) but was significantly lower in Hispanic compared with White patients (IRR, 0.36; 95% CI, 0.33–0.40; P <0.001). After multivariable adjustment, Black race was associated with a lower incidence of surgical aortic valve replacement (IRR, 0.67; 95% CI, 0.55–0.82 P <0.001 relative to White race) and transcatheter aortic valve replacement (IRR, 0.77; 95% CI, 0.65–0.90; P =0.002) among those with any inpatient diagnosis of AS. Hispanic patients had a similar rate of surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients. Conclusions Hospitalization with any diagnosis of AS is less common in Black and Hispanic patients than in White patients. In hospitalized patients with AS, Black race is associated with a lower incidence of both surgical aortic valve replacement and transcatheter aortic valve replacement compared with White patients, whereas Hispanic patients have a similar incidence of both. The reasons for these inequities are likely multifactorial.

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Racial/Ethnic Disparities in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights from the Healthcare Cost and Utilization Project's National Inpatient Sample

Abstract: Purpose: To identify racial/ethnic disparities in utilization rates, in-hospital outcomes and health care resource use among Non-Hispanic Whites (NHW), African Americans (AA) and Hispanics undergoing transcatheter aortic valve replacement (TAVR) in the United States (US).

Cited by 28 publications

References 24 publications

Predictors and outcomes of patient‐prosthesis mismatch after transcatheter aortic valve replacement

Predictors and outcomes of patient‐prosthesis mismatch after transcatheter aortic valve replacement

The safety of health care for ethnic minority patients: a systematic review

Inequities in Aortic Stenosis and Aortic Valve Replacement Between Black/African‐American, White, and Hispanic Residents of Maryland

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