Racial and Ethnic Differences in Treatment and Outcomes of Severe Aortic Stenosis

Wilson, Jimica; Jackson, Larry R.; Ugowe, Francis; Jones, Terrell; Yankey, George S.; Marts, Colin; Thomas, Kevin L.

doi:10.1016/j.jcin.2019.08.056

Cited by 48 publications

(39 citation statements)

References 29 publications

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“…The transcatheter valve therapy (TVT) registry showed that in 70,221 patients undergoing TAVR, the majority (91%) were Caucasians, whereas African Americans, and Hispanics were 3.8 and 3.4%, respectively 28 . The most likely reasons for this disparity are the relatively lower prevalence of AS in racial minorities, 29 referral and detection bias for AVR favoring Whites over other racial groups, 30,31 and limited access to care due to cultural beliefs, or socioeconomic limitations among minorities 31 . Regardless, in the TVT registry, the adjusted 30‐day and 1‐year outcomes in non‐Whites were comparable with those of Whites, 28 suggesting the benefits of TAVR over SAVR are unlikely to be influenced by racial differences.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter versus surgical aortic valve replacement in patients with end stage renal disease

Khan

Kalra

et al. 2020

Cathet Cardio Intervent

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Objective To assess contemporary national trends of comorbidities, outcomes, and health care resource utilization in patients with aortic stenosis (AS) and end‐stage renal disease (ESRD) undergoing transcatheter and surgical aortic valve replacement (TAVR and SAVR). Methods and Results The National‐Inpatient‐Sample was used to study trends in patients with AS and ESRD undergoing TAVR and SAVR between January 2012 and December 2017. Of 12,550 patients, 5,735 underwent TAVR and 6,815 underwent SAVR. Over the years, the utilization of SAVR declined (from 82.0 to 37.7%); and increased for TAVR (from 18.0 to 62.3%; p < .001). Patients receiving TAVR were older (74.6 [9.1] vs. 66.8 years [9.1]), had a higher proportion of females (37.1 vs. 32.5%), Caucasians (68.7 vs. 60.9%) and Asian /Pacific Islanders (3.1 vs. 2.7%; p < .001 for all). The TAVR patients, despite having higher comorbidity burden (anemia, coronary artery disease, chronic pulmonary disease, congestive heart failure, cerebrovascular disease, and peripheral vascular disease) had lower inpatient mortality and complications (ST‐elevation myocardial infarction, pneumonia, pneumothorax, pulmonary embolism, cardiogenic shock, cardiac arrest, and need for mechanical ventilators and vasopressors). The median length of stay (13.9–6.5 days; p < .001) and cost of stay ($311,538.16 to $255,693.40; p < .001) reduced with TAVR; but remained unchanged with SAVR. Higher proportion of patients was discharged home after TAVR vs. SAVR. Conclusion Among patients with AS and ESRD, despite providing therapy to subjects with higher comorbidity burden, TAVR was associated with lower inpatient mortality, complications, length of stay, cost of care, and higher home disposition rates when compared with SAVR.

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Section: Discussionmentioning

confidence: 99%

Transcatheter versus surgical aortic valve replacement in patients with end stage renal disease

Khan

Kalra

et al. 2020

Cathet Cardio Intervent

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“…Past studies revealed that although underrepresented ethnic groups had a high prevalence of risk factors, they had a lower incidence of AS. However, blacks with severe AS had higher morbidity and mortality than whites [20].…”

Section: Discussionmentioning

confidence: 91%

Incidence and Predictors of In-Hospital Mortality Among Diabetics Undergoing Transcatheter Aortic Valve Replacement

Malik

Patel

Joundi

et al. 2021

Cureus

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The main goals of this study are to delineate the differences in demographics, comorbidities and hospital outcomes between diabetic and non-diabetic aortic stenosis (AS) patients, and next is to evaluate the predictors of in-hospital mortality in AS patients undergoing transcatheter aortic valve replacement (TAVR). MethodsWe conducted an observational cross-sectional study using the nationwide inpatient sample (NIS) and included 33,325 adult patients with a primary discharge diagnosis of AS who underwent TAVR during the hospitalization. This sample was further grouped by comorbid diabetic which include non-diabetics (N = 23,585) versus diabetic patients (N = 9,740). Among the hospital outcomes we included the length of stay (LOS) and total cost during hospitalization, and the all-cause in-hospital mortality. We used an independent logistic regression model adjusted for demographic confounders to measure the adjusted odds ratio (aOR) of association of comorbid medical conditions and in-hospital mortality risk in non-diabetic and diabetic groups. ResultsThe most prevalent medical comorbidities among inpatients with diabetes were hypertension (85.1%), followed by renal failure (38.0%), chronic lung disease (37.1%), obesity (21.3%), and these values were significantly higher compared with the non-diabetic group. The in-hospitality mortality was higher among the non-diabetic group (4.7%) compared to the diabetic group (2.8%). There was no significant difference in mean length of stay and mean total cost between the diabetic and non-diabetic groups. In diabetic AS inpatients, stroke (aOR: 4.58, 95%CI: 2.23-9.42) and fluid/electrolyte disorders (aOR: 4.25, 95%CI: 3.29-5.48) had a statistically significant association with mortality risk when compared to the non-diabetic group. Among the non-diabetic AS inpatients, fluid/electrolyte disorders had the highest mortality risk (aOR: 2.48,

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“…In the United States, racial minorities with severe aortic stenosis (AS) are less likely than Whites to have surgical or transcatheter aortic valve replacement (TAVR), with White patients undergoing the more than 90% of valve replacement procedures both in the pre-and post-TAVR eras 57,58 .…”

Section: Racial Disparities In Structural Heart Disease Interventionsmentioning

confidence: 99%

Racism and Cardiology: A Global Call to Action

et al. 2021

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Racial and Ethnic Differences in Treatment and Outcomes of Severe Aortic Stenosis

Cited by 48 publications

References 29 publications

Transcatheter versus surgical aortic valve replacement in patients with end stage renal disease

Transcatheter versus surgical aortic valve replacement in patients with end stage renal disease

Incidence and Predictors of In-Hospital Mortality Among Diabetics Undergoing Transcatheter Aortic Valve Replacement

Racism and Cardiology: A Global Call to Action

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