White patients are recommended for three of the most common structural heart disease (SHD) interventions more often than their black and Hispanic counterparts, according to a recent study published in the Journal of the American Heart Association, but procedural outcomes are similar among the groups.
First author Mohamad Alkhouli, MD, of West Virginia Heart & Vascular Institute, and colleagues investigated race- and ethnicity-based disparities in the use and outcomes of transcatheter aortic valve replacement (TAVR), transcatheter mitral valve repair (TMVR) and percutaneous left atrial appendage occlusion (LAAO)—the most popular SHD therapies in use today—using National Inpatient Sample data from 2011 to 2016. They considered patients aged 65 and up who identified as either white, black or Hispanic.
The team considered a total of 106,119 weighted hospitalizations in their analysis. Utilization rates, defined as the number of procedures performed per 100,000 U.S. residents over age 65, were higher in white patients compared to black and Hispanic patients:
- TAVR usage: 43.1% in whites; 18% in blacks; 21.1% in Hispanics
- TMVR usage: 5% in whites; 3.2% in blacks; 3.2% in Hispanics
- LAAO usage: 6.6% in whites; 2.1% in blacks; 3.5% in Hispanics
The authors said that compared with white patients, black and Hispanic patients had distinctive socioeconomic and clinical risk factors that set them apart.
“The etiology of these large differences in the utilization of common SHD interventions is likely multifactorial, including race- and ethnic-specific differences in the prevalence of specific cardiac pathologies (e.g. aortic stenosis), lack of access to advanced SHD interventions, differences in cultural values and acceptance of invasive treatment, or system-related biases in the provision of care to racial and ethnic minorities,” Alkhouli and colleagues wrote. “For example, Patel et al. found that the prevalence of severe aortic stenosis in black patients is much lower than its prevalence in white patients (0.29% versus 0.91%), although no difference existed in the prevalence of severe mitral regurgitation between the two groups (1.35% in whites versus 1.45% in blacks).
Although usage rates seemed to differ between the groups, Alkhouli and his team reported few differences in adjusted in-hospital mortality or key complications. No significant difference in cost was noted, either, save for modestly higher TMVR and LAAO bills in Hispanic patients compared with white patients.
The authors called their findings “reassuring” and said they’re in line with other studies suggesting similar outcomes of surgical and transcatheter valvular interventions among patients of varying races. Still, they said, the field of SHD interventions is still relatively young, and their results will need to be corroborated.
“Significant racial and ethnic disparities exist in the utilization of common SHD interventions and in the characteristics of patients undergoing these procedures in the U.S.,” Alkhouli et al. wrote. “However, after risk adjustments, no differences were noted in short-term outcomes among white, black and Hispanic patients. Further studies are needed to understand the reasons for these disparities and to identify effective strategies for their mitigation.”