Key result
Compared to White males, in-hospital mortality after TAVR was significantly higher for Hispanic males (OR 1.9; 95% CI 1.2-3.0), Hispanic females (OR 1.9), and White females (OR 1.4).
Why the study?
Despite rapid growth in TAVR use over time, understanding of its use and outcomes among males and females of underrepresented racial and ethnic groups remains limited.
Do transcatheter aortic valve replacement use and outcomes differ by race, ethnicity, and sex in patients undergoing aortic valve replacement?
Observational (n=91,693)
Yes
Do transcatheter aortic valve replacement use and outcomes differ by race, ethnicity, and sex in patients undergoing aortic valve replacement?
Odds Ratio: 1.9 (95% CI 1.2–3)
Significant disparities exist in TAVR utilization and in-hospital outcomes based on race, ethnicity, and sex, with higher mortality observed in Hispanic patients and White females compared to White males.
TAVR disparities by race and sex should not yet change practice; hypothesis-generating and requires prospective confirmation.
OBJECTIVES: To identify trends in transcatheter aortic valve replacement (TAVR) use and outcomes by race (non-Hispanic White, Black), ethnicity (Hispanic), and sex over time. BACKGROUND: Despite rapid growth in TAVR use over time, our understanding of its use and outcomes among males and females of underrepresented racial/ethnic groups remains limited. METHODS: A retrospective analysis of hospitalizations from 2013 to 2017 from the Healthcare Cost and Utilization Project database was performed. RESULTS: ) of all hospitalizations, yet they comprised 83% (n = 176,887) of the admissions for aortic stenosis (p < 0.0001). Among 91,693 hospitalizations for aortic valve replacement, 64,069 were surgical (34.0% female, 7.0% Hispanic, and 5.9% Black) and 27,624 were transcatheter (46.6% female, 4.5% Hispanic, and 4.4% Black). Growth in TAVR volumes was the slowest among minorities and females. Hispanic males, Hispanic females, and White females had the highest in-hospital mortality (2.7%-3.3%; compared to White males, adjusted odds ratio: Hispanic males 1.9 [1.2-3.0], Hispanic females 1.9 [1.2-3.1], and White females 1.4 [1.2-1.7]). Despite less baseline vascular disease, females of all races/ethnicities had more vascular complications than men (female 5% vs. male 3.5%, p ≤ 0.001). Further adjustment for vascular complications only partially attenuated mortality differences. Black and Hispanic patients had a longer mean length of hospital stay than White patients, which was most pronounced among females. Pacemaker requirements were consistently low among all groups. CONCLUSION: Differences in TAVR growth and outcomes by race, ethnicity, and sex over time highlight areas for focused efforts to close gaps in minimally invasive structural heart disease care.
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Yong et al. (2022) conducted an observational in Aortic stenosis (n=91,693). Hispanic ethnicity and female sex vs. White males was evaluated on In-hospital mortality (OR 1.9, 95% CI 1.2-3.0). Compared to White males, in-hospital mortality after TAVR was significantly higher for Hispanic males (OR 1.9; 95% CI 1.2-3.0), Hispanic females (OR 1.9), and White females (OR 1.4).
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