Sparrow, R, Sanjoy, S, Choi, Y-H, Elgendy, IY, Jneid, H, Villablanca, PA, Holmes, DR, Pershad, A, Alraies, C, Sposato, LA, Mamas, MA ORCID: https://orcid.org/0000-0001-9241-8890 and Bagur, R ORCID: https://orcid.org/0000-0003-1888-9429 (2021) Racial, ethnic and socioeconomic disparities in patients undergoing left atrial appendage closure. Heart.

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Abstract

OBJECTIVE: This manuscript aims to explore the impact of race/ethnicity and socioeconomic status on in-hospital complication rates after left atrial appendage closure (LAAC). METHODS: The US National Inpatient Sample was used to identify hospitalisations for LAAC between 1 October 2015 to 31 December 2018. These patients were stratified by race/ethnicity and quartiles of median neighbourhood income. The primary outcome was the occurrence of in-hospital major adverse events, defined as a composite of postprocedural bleeding, cardiac and vascular complications, acute kidney injury and ischaemic stroke. RESULTS: Of 6478 unweighted hospitalisations for LAAC, 58% were male and patients of black, Hispanic and 'other' race/ethnicity each comprised approximately 5% of the cohort. Adjusted by the older Americans population, the estimated number of LAAC procedures was 69.2/100 000 for white individuals, as compared with 29.5/100 000 for blacks, 47.2/100 000 for Hispanics and 40.7/100 000 for individuals of 'other' race/ethnicity. Black patients were ~5 years younger but had a higher comorbidity burden. The primary outcome occurred in 5% of patients and differed significantly between racial/ethnic groups (p<0.001) but not across neighbourhood income quartiles (p=0.88). After multilevel modelling, the overall rate of in-hospital major adverse events was higher in black patients as compared with whites (OR: 1.60, 95% CI 1.22 to 2.10, p<0.001); however, the incidence of acute kidney injury was higher in Hispanics (OR: 2.19, 95% CI 1.52 to 3.17, p<0.001). No significant differences were found in adjusted overall in-hospital complication rates between income quartiles. CONCLUSION: In this study assessing racial/ethnic disparities in patients undergoing LAAC, minorities are under-represented, specifically patients of black race/ethnicity. Compared with whites, black patients had higher comorbidity burden and higher rates of in-hospital complications. Lower socioeconomic status was not associated with complication rates.

Item Type: Article
Additional Information: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. The final version of this accepted manuscript can also be found online at; https://heart.bmj.com/content/early/2021/03/31/heartjnl-2020-318650?hwshib2=authn%3A1620298812%3A20210505%253Af6413920-06e0-4c8b-8659-3f63693f8ca3%3A0%3A0%3A0%3AkwC6s%2FWnNHGYIWAbzJu2Bw%3D%3D
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
R Medicine > RD Surgery
R Medicine > RD Surgery > RD32 Operative surgery. Technique of surgical operations
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 05 May 2021 11:04
Last Modified: 05 May 2021 11:04
URI: https://eprints.keele.ac.uk/id/eprint/9480

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