Racial and Ethnic Differences in AS

Wilson JB, Jackson II LR, Ugowe FE, et al.
Racial and Ethnic Differences in Treatment and Outcomes of Severe Aortic Stenosis: A Review. JACC Cardiovasc Interv 2020;13:149-56.

The following are the key points to remember from a review highlighting the differences in underrepresented racial/ethnic groups in the management and outcomes of aortic stenosis (AS):

  1. Analysis of the data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample shows that the diagnosis of AS was less prevalent in underrepresented racial and ethnic groups (UREGs). It was determined that the diagnosis of AS was missed in UREGs more frequently than white patients.
  2. Black patients have a lower prevalence of bicuspid aortic valve compared with white patients.
  3. UREGs possess higher rates of traditional AS risk factors such as heart failure, chronic kidney disease, smoking, hypertension, obesity, and diabetes mellitus.
  4. UREGs are less likely to undergo surgical aortic valve replacement than white patients.
  5. Black patients with aortic valve disease had 54% lower odds of being referred to cardiothoracic surgery than white patients. UREGs were found to have increased burden of comorbidities; those were the most common reasons for not having surgery.
  6. When controlling for comorbidities, black race was not a significant predictor of operative mortality after surgical aortic valve replacement, but black patients had prolonged intubation and ventilation, longer post-operative stay, and higher reoperation rates for bleeding.
  7. Black patients receive transcatheter aortic valve replacement (TAVR) less often than white patients (3.8% vs. 93.8%).
  8. The odds of undergoing TAVR increase by 10% for every $10,000 increase in income (p = 0.05).
  9. UREGs who are referred for TAVR share similar risks and outcomes compared with white patients.
  10. In patients who had TAVR, post-procedural mortality risk was equal between races, but black patients had higher rates of hemodynamic instability and use of intra-aortic balloon pumps.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Interventions, CHD and Pediatrics and Quality Improvement, Interventions and Structural Heart Disease

Keywords: Aortic Valve Stenosis, Heart Valve Diseases, Aortic Valve, Ethnic Groups, African Americans, Transcatheter Aortic Valve Replacement, Heart Valve Prosthesis, Prevalence, Risk Factors, Heart Defects, Congenital, Treatment Outcome

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