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Temporal trends in utilization and outcomes of transcatheter aortic valve replacement in different races: an analysis of the national inpatient sample

Ullah, Waqas; Al-Khadra, Yasser; Mir, Tanveer; Darmoch, Fahed; Pacha, Homam M.; Sattar, Yasar; Ijioma, Nketchi; Mohamed, Mohamed O.; Kwok, Chun S.; Asfour, Abedelrahim I.; Kapadia, Samir; Rizik, David; Zehr, Kenton; Mamas, Mamas A.; Alraies, M. Chadi

Authors

Waqas Ullah

Yasser Al-Khadra

Tanveer Mir

Fahed Darmoch

Homam M. Pacha

Yasar Sattar

Nketchi Ijioma

Mohamed O. Mohamed

Chun S. Kwok

Abedelrahim I. Asfour

Samir Kapadia

David Rizik

Kenton Zehr

M. Chadi Alraies



Abstract

AIM: We sought to determine the racial and ethnical disparities in the delivery of TAVR and to evaluate the in-hospital outcomes and utilization of TAVR stratified by patient ethnicity. METHOD: Using a national inpatient sample database between 2011 and 2015, we identified all adult patients who had TAVR. Races were identified and white race was set as control. Multiple logistic regression analysis was performed for the primary outcome of in-hospital mortality. RESULTS: Out of 58?174 patients who underwent TAVR, 50?809 (87.3%) were white, 2327 (4.0%) were black, 2311 (4.0%) were Hispanic, 640 (1.1%) Asian, 105 (0.2%) Native American and 1982 (3.4%) of other ethnicities. We found a statistically significant linear uptrend in the utilization of TAVR in patients of all races between the years 2011 and 2015. White, black, Hispanic and Native American patients had a downward linear trend for mortality during the studied years (P?=?0.005 for all). Black patients had lower in-hospital mortality [2.8 vs. 3.6%, odds ratio (OR)?=?0.62; 95% confidence interval (CI) 0.44, 0.81 P?<?0.001] compared with white patients, whereas Hispanic patients and Native Americans had higher in-hospital mortality compared with white patients (4.5% OR 1.26; 95% CI 1.01, 1.56 P?=?0.041), (9.5% OR 4.44; 95% CI 2.25, 8.77 P?<?0.001), respectively. CONCLUSION: Overall, TAVR utilization is associated with lower mortality. There is a rising trend in utilization of TAVR in the black population with a significantly favorable mortality trend compared with the white population.

Journal Article Type Article
Acceptance Date Jan 31, 2021
Online Publication Date Feb 26, 2021
Publication Date Jul 1, 2021
Journal J Cardiovasc Med (Hagerstown)
Print ISSN 1558-2027
Publisher Lippincott, Williams & Wilkins
Volume 22
Issue 7
Pages 586 - 593
DOI https://doi.org/10.2459/JCM.0000000000001172
Keywords mortality; race; transcatheter aortic valve replacement

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