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. 2019 Aug 6;8(15):e012125.
doi: 10.1161/JAHA.119.012125. Epub 2019 Jul 18.

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

Mohamad Alkhouli  1   2 , Fahad Alqahtani  1 , David R Holmes  2 , Chalak Berzingi  1
Affiliations

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

Mohamad Alkhouli et al. J Am Heart Assoc. .

Abstract

Background Data on race- and ethnicity-based disparities in the utilization and outcomes of structural heart disease interventions in the United States are scarce. Methods and Results We used the National Inpatient Sample (2011-2016) to examine racial and ethnic differences in the utilization, in-hospital outcomes, and cost of structural heart disease interventions among patients ≥65 years of age. A total of 106 119 weighted hospitalizations for transcatheter aortic valve replacement, transcatheter mitral valve repair, and left atrial appendage occlusion were included. The utilization rates (defined as the number of procedures performed per 100 000 US people >65 years of age) were higher in whites compared with blacks and Hispanics for transcatheter aortic valve replacement (43.1 versus 18.0 versus 21.1), transcatheter mitral valve repair (5.0 versus 3.2 versus 3.2), and left atrial appendage occlusion (6.6 versus 2.1 versus 3.5), respectively (P<0.001). Black and Hispanic patients had distinctive socioeconomic and clinical risk profiles compared with white patients. There were no significant differences in the adjusted in-hospital mortality or key complications between patients of white race, black race, and Hispanic ethnicity following transcatheter aortic valve replacement, transcatheter mitral valve repair, or left atrial appendage occlusion. No difference in cost was observed between white and black patients following any of the 3 procedures. However, Hispanic patients incurred modestly higher cost with transcatheter mitral valve repair and left atrial appendage occlusion compared with white patients. Conclusions Racial and ethnic disparities exist in the utilization of structural heart disease interventions in the United States. Nonetheless, adjusted in-hospital outcomes were comparable among white, black, and Hispanic patients. Further studies are needed to understand the reasons for these utilization disparities.

Keywords: aortic stenosis; atrial fibrillation; left atrial appendage; mitral valve regurgitation; transcatheter aortic valve implantation.

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Figures

Figure 1
Figure 1
Study flowchart. FDA indicates Food and Drug Administration; LAAO, left atrial appendage occlusion; N, number; NIS, National Inpatient Sample; SHD, structural heart disease; TAVR, transcatheter aortic valve replacement; TMVr, transcatheter mitral valve repair. *Weighted.
Figure 2
Figure 2
Racial and ethnic differences in the utilization of common structural heart interventions in the United States. A, Racial/ethnic differences in the utilization of TAVR. B, Racial/ethnic differences in the utilization of TMVr. C, Racial/ethnic differences in the utilization of LAAO. LAAO indicates left atrial appendage occlusion; TAVR, transcatheter aortic valve replacement; TMVr, transcatheter mitral valve repair.
See this image and copyright information in PMC

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