Temporal trends in transcatheter aortic valve replacement use and outcomes by race, ethnicity, and sex

Abstract

Objectives: To identify trends in transcatheter aortic valve replacement (TAVR) use and outcomes by race (non-Hispanic White, Black), ethnicity (Hispanic), and sex over time.Background: Despite rapid growth in TAVR use over time, our understanding of its use and outcomes among males and females of underrepresented racial/ethnic groups remains limited.Methods: A retrospective analysis of hospitalizations from 2013 to 2017 from the Healthcare Cost and Utilization Project database was performed.Results: White patients comprised 65% (n = 2.16 × 10 7 ) of all hospitalizations, yet they comprised 83% (n = 176,887) of the admissions for aortic stenosis (p < 0.0001).Among 91,693 hospitalizations for aortic valve replacement, 64,069 were surgical (34.0% female, 7.0% Hispanic, and 5.9% Black) and 27,624 were transcatheter (46.6% female, 4.5% Hispanic, and 4.4% Black). Growth in TAVR volumes was the slowest among minorities and females. Hispanic males, Hispanic females, and White females had the highest in-hospital mortality (2.7%-3.3%; compared to White males, adjusted odds ratio: Hispanic males 1.9 [1.2-3.0], Hispanic females 1.9 [1.2-3.1],and White females 1.4 [1.2-1.7]). Despite less baseline vascular disease, females of all races/ethnicities had more vascular complications than men (female 5% vs. male 3.5%, p ≤ 0.001). Further adjustment for vascular complications only partially attenuated mortality differences. Black and Hispanic patients had a longer mean length of hospital stay than White patients, which was most pronounced among females. Pacemaker requirements were consistently low among all groups.Conclusion: Differences in TAVR growth and outcomes by race, ethnicity, and sex over time highlight areas for focused efforts to close gaps in minimally invasive structural heart disease care.

Racial and Ethnic Differences in Obesity Treatment in the Veterans Affairs Healthcare System

“…and bariatric surgery use are similar to others’ within VA (13,17). Our analysis does not extend to more novel surgical or endoscopic interventions, however given data suggesting late adoption of novel therapies among minoritized individuals (21,50), we expect this information would only exacerbate the severity of inequities identified rather than change the findings. Finally, we cannot determine the extent to which whether the differences we see between race/ethnicity groups are attributable to differential treatment preferences by race/ethnicity, or other mechanisms.…”

“…Incretin-based injectable medications join the existing arsenal of evidence-based, guidelinerecommended obesity treatments, including behavioral weight loss programs, older anti-obesity medications, and bariatric surgery (8)(9)(10)(11)(12), all of which were underutilized in the era prior to incretinbased therapy (13)(14)(15)(16)(17)(18)(19). As marginalized populations frequently receive healthcare innovations slower and later than more resource-rich counterparts (20,21)-and given inequities in use of existing obesity treatments (18,19,(22)(23)(24)(25)-it is far from certain that these next-generation medications are diffusing equitably. Indeed, early experiences suggest the opposite (26); however, inequalities are often attributed to insurance coverage or ability to pay.…”

Association between hospital racial composition and aortic valve replacement outcomes: A national inpatients sample database analysis

“…Yet, racial and ethnic differences are significant in the application and outcomes of aortic valve replacement. [5][6][7][8][9] While some recent studies have identified patient-related factors influencing these disparities, the role of hospital-related factors remains less clear.…”

Outcome of transcatheter aortic valve replacement in Israeli Jews and Arabs

“…Severe symptomatic aortic stenosis is associated with high mortality, which may be prevented by timely valve replacement ( 3 , 4 ). Transcatheter aortic valve replacement (TAVR) is an effective therapy for severe symptomatic aortic stenosis ( 3 , 4 ), however several studies have documented disparities in access to TAVR among different racial and ethnic groups ( 5 , 6 ). Treatment disparities may arise from differences in socioeconomic, cultural, immigration-related, and genetic factors, as well as the conscious or unconscious racial bias of health care providers ( 7 ).…”