Racial Minorities Less Likely to Undergo TAVR, NCDR Study Shows
Racial minorities may be less likely than white patients to undergo TAVR in the U.S., but their in-hospital and one-year outcomes following TAVR are similar to those of white patients, according to a study published May 20 in JACC: Cardiovascular Interventions.
Mohamad Alkhouli, MD, FACC, et al., used the STS/ACC TVT Registry to analyze records of 70,221 patients age 65 and older who underwent TAVR. The researchers linked registry data to claims data from the Centers for Medicare and Medicaid Services to assess one-year outcomes in a subset of 29,351 patients. The study's primary outcome was in-hospital and one-year all-cause mortality.
Among all patients, 91.3 percent were white, 3.8 percent were black, 3.4 percent were Hispanic and 1.5 percent were Asian/Native American/Pacific Islander. Although black and Hispanic individuals represented 8 percent to 9 percent of the U.S. population age 65 and older throughout the study period, these groups represented less than 4 percent of TAVR patients. In-hospital mortality was 3.5 percent among all patients.
After risk-adjustment, there were no differences in-hospital mortality among the four groups. At one year, all-cause mortality rates were similar among white, black and Hispanic patients, but lower in Asian/Native American/Pacific Islander patients than in white patients. Black and Hispanic patients had higher rates of heart failure readmission than white patients, but there were no other differences in other outcomes among the four groups.
Although the study "documents an underrepresentation of racial minorities among patients undergoing TAVR," it shows TAVR was associated with "excellent short-term and midterm results across all racial groups," the authors conclude. They note moving forward, additional research is needed to determine reasons for disparities and to "develop an effective strategy for their mitigation."
Michele Doughty Voeltz, MD, and William O'Neill, MD, FACC, write in an accompanying editorial comment that a "multifaceted program" is needed to "expand the utilization of this and other new lifesaving cardiac procedures." They conclude that, "Hopefully in five years, the medical establishment will make significant progress in this area."
Keywords: Risk Adjustment, Hospital Mortality, Transcatheter Aortic Valve Replacement, Centers for Medicare and Medicaid Services, U.S., Patient Readmission, Registries, National Cardiovascular Data Registries, STS/ACC TVT Registry
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