Impact of sex on in‐hospital mortality and 90‐day readmissions in patients undergoing transcatheter mitral valve replacement (TMVR): Analysis from the nationwide readmission database

Ismayl, Mahmoud; Balakrishna, Akshay Machanahalli; Elgayesh, Mostafa M; Thandra, Abhishek; Gill, Gauravpal S.; Niu, Fang; Agarwal, Himanshu; Aboeata, Ahmed; Goldsweig, Andrew M.; Smer, Aiman

doi:10.1002/ccd.30549

Cited by 3 publications

(2 citation statements)

References 44 publications

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“… 7 , 31 There was a significant increase in the use of TMVR from 2016 to 2020 across all racial and ethnic groups and in both sexes. 32 Similarly, previous studies found an upward trend in other transcatheter valvular procedures in White and Black patients. 16 , 33 Elbadawi et al found that M‐TEER was increasingly performed in both White and Black patients at similar rates.…”

Section: Discussionmentioning

confidence: 67%

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

Ismayl

Abbasi

Al-abcha

et al. 2023

JAHA

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Background Racial and ethnic disparities in outcomes exist following many cardiac procedures. Transcatheter mitral valve replacement (TMVR) has grown as an alternative to mitral valve surgery for patients at high surgical risk. The outcomes of TMVR by race and ethnicity are unknown. We aimed to evaluate racial and ethnic disparities in the outcomes of TMVR. Methods and Results We analyzed the National Inpatient Sample database from 2016 to 2020 to identify hospitalizations for TMVR. Racial and ethnic disparities in TMVR outcomes were determined using logistic regression models. Between 2016 and 2020, 5005 hospitalizations for TMVR were identified, composed of 3840 (76.7%) White race, 505 (10.1%) Black race, 315 (6.3%) Hispanic ethnicity, and 345 (6.9%) from other races (Asian, Pacific Islander, American Indian or Alaska Native, Other). Compared with other racial and ethnic groups, Black patients were significantly younger and more likely to be women (both P <0.01). There were no significant differences between White, Black, and Hispanic patients in in‐hospital mortality (5.2% versus 5.0% versus <3.5%; P =0.89) and procedural complications, including heart block ( P =0.91), permanent pacemaker ( P =0.49), prosthetic valve dysfunction ( P =0.45), stroke ( P =0.37), acute kidney injury ( P =0.32), major bleeding ( P =0.23), and blood transfusion ( P =0.92), even after adjustment for baseline characteristics. Adjusted vascular complications were higher in Black compared with White patients ( P =0.03). Trend analysis revealed a significant increase in TMVR in all racial and ethnic groups from 2016 to 2020 ( P trend <0.05). Conclusions Between 2016 and 2020, Black and Hispanic patients undergoing TMVR had similar in‐hospital outcomes compared with White patients, except for higher vascular complications in Black patients. Further comparative studies of TMVR in clinically similar White patients and other racial and ethnic groups are warranted to confirm our findings.

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Section: Discussionmentioning

confidence: 67%

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

Ismayl

Abbasi

Al-abcha

et al. 2023

JAHA

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“…While different in scope from our study, studies that focus exclusively on transcatheter interventions, both edge‐to‐edge repair and replacement, have shown equivalent or improved outcomes for women compared with men. 23 , 24 , 25 The reasons underlying this difference between surgical and transcatheter outcomes between men and women are unclear and require further investigation.…”

Section: Discussionmentioning

confidence: 99%

Gender and Sex Differences in the Management, Intervention, and Outcomes of Patients With Severe Primary Mitral Regurgitation

Waldron,

Hundito,

Krane

et al. 2024

JAHA

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Background Gender‐ and sex‐based disparities in mitral valve disease exist; however the factors associated with these differences are unknown. Identifying these differences is essential in devising mitigating strategies. We evaluated gender and sex differences among patients with severe primary mitral regurgitation (MR) across treatment phases. Methods and Results We conducted a retrospective cohort study of patients with new diagnoses of severe primary MR between 2016 and 2020. We compared multidisciplinary evaluation incidence and 2‐year survival between men and women. We analyzed a subgroup meeting class 1 indications for intervention, which includes severe symptomatic MR or severe asymptomatic MR with ejection fraction <60% or left ventricular end‐systolic diameter >40 mm. Logistic regression models identified predictors associated with the likelihood of multidisciplinary evaluation. Among 330 patients meeting class 1 indications, women were older (79 versus 76 years, P =0.01) and had higher Society of Thoracic Surgeons risk scores for mitral valve repair than men (2.5% versus 1.4%, P =0.003). Women were less likely to undergo multidisciplinary evaluation (57% versus 84%, P <0.001) and intervention (47% versus 69%, P <0.001) than men. Median days to intervention for women and men were 77 and 43, respectively. Women had a higher 2‐year mortality rate than men (31% versus 21%, P =0.035). On a multivariable model, female sex and older age were associated with lower odds of undergoing multidisciplinary evaluation (odds ratio, 0.26; P <0.001; odds ratio, 0.95; P <0.001, respectively). Conclusions Women with severe primary MR with class 1 indication for intervention were less likely to undergo multidisciplinary evaluation and intervention and had a longer interval to intervention than men. Survival was comparable after accounting for age and comorbidity differences.

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Economic Disparities in Utilization and Outcomes of Structural Heart Disease Interventions in the United States

Ismayl,

Ahmed,

Goldsweig

et al. 2024

JACC: Advances

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Impact of sex on in‐hospital mortality and 90‐day readmissions in patients undergoing transcatheter mitral valve replacement (TMVR): Analysis from the nationwide readmission database

Cited by 3 publications

References 44 publications

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

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

Gender and Sex Differences in the Management, Intervention, and Outcomes of Patients With Severe Primary Mitral Regurgitation

Economic Disparities in Utilization and Outcomes of Structural Heart Disease Interventions in the United States

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