Racial/Ethnic Disparities in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights from the Healthcare Cost and Utilization Project's National Inpatient Sample

Dagmar F. Hernandez-Suarez, Sagar Ranka, Pedro Villablanca, Nicole Yordan-Lopez, Lorena González-Sepúlveda, Jose Wiley, Cristina Sanina, Abiel Roche-Lima, Brenda G. Nieves-Rodriguez, Stacey Thomas, Pedro Cox-Alomar, Angel Lopez-Candales, Harish Ramakrishna

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Abstract

Purpose: To identify racial/ethnic disparities in utilization rates, in-hospital outcomes and health care resource use among Non-Hispanic Whites (NHW), African Americans (AA) and Hispanics undergoing transcatheter aortic valve replacement (TAVR) in the United States (US). Methods and results: The National Inpatient Sample database was queried for patients ≥18 years of age who underwent TAVR from 2012 to 2014. The primary outcome was all-cause in hospital mortality. A total of 36,270 individuals were included in the study. The number of TAVR performed per million population increased in all study groups over the three years [38.8 to 103.8 (NHW); 9.1 to 26.4 (AA) and 9.4 to 18.2 (Hispanics)]. The overall in-hospital mortality was 4.2% for the entire cohort. Race/ethnicity showed no association with in-hospital mortality (P >.05). Though no significant difference were found between AA and NHW in any secondary outcome, being Hispanic was associated with higher incidence of acute myocardial infarction (aOR = 2.02; 95% CI, 1.06–3.85; P =.03), stroke/transient ischemic attack (aOR = 1.81; 95% CI, 1.04–3.14; P =.04), acute kidney injury (aOR = 1.65; 95% CI, 1.23–2.21; P <.01), prolonged length of stay (aOR = 1.18; 95% CI, 1.08–1.29; P <.01) and higher hospital costs (aOR = 1.27; 95% CI, 1.18–1.36; P <.01). Conclusion: There are significant racial disparities in patients undergoing TAVR in the US. Though in-hospital mortality was not associated with race/ethnicity, Hispanic patients had less TAVR utilization, higher in-hospital complications, prolonged length of stay and increased hospital costs.

Original languageEnglish (US)
Pages (from-to)546-552
Number of pages7
JournalCardiovascular Revascularization Medicine
Volume20
Issue number7
DOIs
StatePublished - Jul 2019

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Keywords

  • Comparative outcomes
  • Disparity
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Hernandez-Suarez, D. F., Ranka, S., Villablanca, P., Yordan-Lopez, N., González-Sepúlveda, L., Wiley, J., Sanina, C., Roche-Lima, A., Nieves-Rodriguez, B. G., Thomas, S., Cox-Alomar, P., Lopez-Candales, A., & Ramakrishna, H. (2019). Racial/Ethnic Disparities in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights from the Healthcare Cost and Utilization Project's National Inpatient Sample. Cardiovascular Revascularization Medicine, 20(7), 546-552. https://doi.org/10.1016/j.carrev.2019.04.005