Patients with valvular heart disease were significantly less likely to receive transthoracic echocardiograms (TTEs) within guideline-recommended timeframes if they were women, black, older or used Medicaid insurance, according to a single-center study published in JACC: Cardiovascular Imaging.
“Black patients with aortic stenosis receive aortic valve replacements less often than white patients, and women have greater mortality following valve surgery,” wrote lead author Varsha K. Tanguturi, MD, and colleagues, all with Massachusetts General Hospital (MGH). “Although little is known about the etiology of these disparities, understanding the mechanisms underlying them is essential to improving health equity.”
Researchers studied more than 130,000 TTEs performed at MGH between 2001 and March 2016. The TTEs represented 42,289 unique patients, all of whom had primary mitral regurgitation, aortic stenosis or aortic insufficiency.
Tanguturi et al. sought to determine how often various groups received TTEs within the recommended timeframes based on patients’ disease type and severity. They found:
- Women were 10 percent less likely than men to receive appropriate TTE surveillance.
- Black patients were 26 percent less likely than whites to receive guideline-recommended TTEs. The rate of appropriate TTEs was similar for Asian, white and Hispanic individuals.
- Medicaid patients were 15 percent less likely to have timely TTEs performed than Medicare patients.
- Each decade of life after age 60 was associated with a significant decrease in the odds of receiving appropriate echos.
“Although we are unable to account for studies performed outside our system, we are reassured that our main findings persisted in a cohort cared for largely at MGH,” the authors wrote. “These results should encourage interventions to improve adherence to consensus guidelines and suggest the need for further investigation into clinical consequences of delayed surveillance.”