Robert T. Sparrow
Racial, ethnic and socioeconomic disparities in patients undergoing transcatheter mitral edge-to-edge repair.
Sparrow, Robert T.; Sanjoy, Shubrandu S.; Lindman, Brian R.; Tang, Gilbert H.L.; Kaneko, Tsuyoshi; Wasfy, Jason H.; Pershad, Ashish; Villablanca, Pedro A.; Guerrero, Mayra; Chadi Alraies, M.; Choi k, Yun-Hee; Sposato, Luciano A.; Mamas, Mamas A.; Bagur, Rodrigo
Authors
Shubrandu S. Sanjoy
Brian R. Lindman
Gilbert H.L. Tang
Tsuyoshi Kaneko
Jason H. Wasfy
Ashish Pershad
Pedro A. Villablanca
Mayra Guerrero
M. Chadi Alraies
Yun-Hee Choi k
Luciano A. Sposato
Mamas Mamas m.mamas@keele.ac.uk
Rodrigo Bagur
Abstract
BACKGROUND: Transcatheter mitral edge-to-edge repair (TEER) is an increasingly common procedure performed on patients with severe mitral regurgitation. This study assessed the impact of race/ethnicity and socioeconomic status on in-hospital complications after TEER. METHODS: Cohort-based observational study using the National Inpatient Sample between October 2013 and December 2018. The population was stratified into 4 groups based on race/ethnicity and quartiles of neighborhood income levels. The primary outcome was in-hospital complications, defined as the composite of death, bleeding, cardiac and vascular complications, acute kidney injury, and ischemic stroke. RESULTS: 3795 hospitalizations for TEER were identified. Patients of Black and Hispanic race/ethnicity comprised 7.4% and 6.4%, respectively. We estimated that White patients received TEER with a frequency of 38.0/100,000, compared to 29.7/100,000 for Blacks and 30.5/100,000 for Hispanics. In-hospital complications occurred in 20.2% of patients and no differences were found between racial/ethnic groups (P = 0.06). After multilevel modelling, Black and Hispanic patients had similar rate of overall in-hospital complications (OR: 0.84, CI:0.67-1.05 and OR: 0.84, CI:0.66-1.07, respectively) as compared to White patients, however, higher rates of death were observed in Black patients. Individuals living in income quartile-1 had worse in-hospital outcomes as compared to quartile-4 (OR: 1.19, CI:0.99-1.42). CONCLUSION: In this study assessing racial/ethnic disparities in TEER outcomes, aged-adjusted race/ethnicity minorities were less underrepresented as compared to other structural heart interventions. Black patients experienced a higher rate of in-hospital death, but similar overall rate of post-procedural adverse events as compared to White patients. Lower income levels appear to negatively impact on in-hospital outcomes. BRIEF SUMMARY: This study appraises race/ethnic and socioeconomical disparities in access and outcomes following transcatheter mitral edge-to-edge repair. Racial minority groups were less underrepresented as compared to other structural heart interventions. While Black patients experienced a higher rate of in-hospital death, they experienced similar overall rate of post-procedural complications compared to White patients. Lower income levels also appeared to negatively impact on outcomes.
Acceptance Date | Sep 17, 2021 |
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Publication Date | Sep 21, 2021 |
Journal | International Journal of Cardiology |
Print ISSN | 0167-5273 |
Publisher | Elsevier |
Pages | 73 - 81 |
DOI | https://doi.org/10.1016/j.ijcard.2021.09.037 |
Publisher URL | https://www.sciencedirect.com/science/article/abs/pii/S0167527321014789 |
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