Robbie Sparrow
Racial, ethnic and socioeconomic disparities in patients undergoing left atrial appendage closure
Sparrow, Robbie; Sanjoy, Shubrandu; Choi, Yun-Hee; Elgendy, Islam Y.; Jneid, Hani; Villablanca, Pedro A.; Holmes, David R.; Pershad, Ashish; Alraies, Chadi; Sposato, Luciano A.; Mamas, Mamas A.; Bagur, Rodrigo
Authors
Shubrandu Sanjoy
Yun-Hee Choi
Islam Y. Elgendy
Hani Jneid
Pedro A. Villablanca
David R. Holmes
Ashish Pershad
Chadi Alraies
Luciano A. Sposato
Mamas Mamas m.mamas@keele.ac.uk
Rodrigo Bagur
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.
Journal Article Type | Article |
---|---|
Acceptance Date | Feb 26, 2021 |
Online Publication Date | Nov 25, 2021 |
Publication Date | Apr 1, 2021 |
Publicly Available Date | May 30, 2023 |
Journal | Heart |
Print ISSN | 1355-6037 |
Publisher | BMJ Publishing Group |
Peer Reviewed | Peer Reviewed |
Volume | 107 |
Issue | 24 |
Pages | 1946-1955 |
DOI | https://doi.org/10.1136/heartjnl-2020-318650 |
Publisher URL | http://dx.doi.org/10.1136/heartjnl-2020-318650 |
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