Socioeconomic and racial disparities were associated with patients with severe AS receiving TAVR at a major referral center. This study emphasizes the importance of improving access to standard of care for these subgroups of cardiac patients.

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Background: Risk stratification is critical in heart failure (HF) and the Meta-Analysis Global Group in Chronic HF (MAGGIC) score is a validated tool derived from ~40,000 patients. However, few of these patients self-identified as Black, raising uncertainty regarding performance in African Americans (AA) with HF. Methods: This study analyzed a racially diverse group of 4046 patients (1646 AA and 2400 White) from a single center from 2007 to 2015. Baseline characteristics were collected to tabulate MAGGIC score and test its discrimination and calibration within race groups. The primary endpoint was all-cause mortality. Death was detected using system records and the social security death master file. Discrimination was tested using Cox models of MAGGIC score stratified by race, and combined analysis including MAGGIC, race, and MAGGIC*race. Calibration was assessed using linear regression models and plots of observed vs. predicted data. Results: Overall, 901 (21%) patients died during 1-year follow-up. MAGGIC score discrimination was similar in both race groups in terms of C-statistic (0.707 ±0.027 vs. 0.725 ±0.014, for AA vs. White, p=0.556) and the hazard ratio (HR) per MAGGIC point was 1.12 in AA patients (95%CI 1.10, 1.14) and 1.13 in White patients (95%CI 1.12, 1.14). Race was a significant correlate of survival, with better survival in AA patients compared to White (HR=0.66; 95% CI 0.56, 0.78), but the interaction of MAGGIC*race was not significant (β= −0.013, p=0.16), and adding race to the model did not improve discrimination (C-statistic for MAGGIC vs. MAGGIC +Race 0.721 vs. 0.722, p=0.79). In calibration testing, the slope was not significantly different from 1 in either group, but the groups differed from each other, and it was closer to unity among AA (0.94 vs 1.4, p=0.004).

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