Inequities in aortic stenosis and aortic valve replacement between black/African American, white, and Hispanic patients

1. In a large cohort of hospitalized patients in Maryland, it was found that Black patients with aortic stenosis had a lower incidence of surgical treatment when compared to their White counterparts.

Evidence Rating Level: 2 (Good)

Aortic stenosis is one of the most common valvular heart diseases which is managed through a surgical aortic valve replacement (SAVR) or a transcatheter aortic valve replacement (TAVR). Racial inequities have been recognized in cardiology interventions such as these however the extent of this problem has not been investigated. This retrospective cohort study aims to assess the extent of racial/ethnic inequities in aortic stenosis, SAVR, and TAVR. The study cohort consisted of 433,078 hospitalized patients in Maryland, from which 14,336 patients had aortic stenosis and 418,742 did not have aortic stenosis. It found that among hospitalized patients in Maryland, Black and Hispanic patients had a lower incidence of any inpatient diagnosis of aortic stenosis (IRR, 0.45; 95% CI, 0.42–0.49; P<0.001 for Black versus White; and IRR, 0.67; 95% CI, 0.58–0.78; P<0.001 for Hispanic versus White). Among patients with an inpatient diagnosis of aortic stenosis, Black patients had a significantly decreased incidence of SAVR when compared to White patients (1934 versus 2916; IRR, 0.66; 95% CI, 0.55–0.79; P<0.001) and Hispanic patients (1934 versus 4036; IRR, 2.09; 95% CI, 1.31–3.21; P=0.002). Similarly, among patients in an inpatient diagnosis of aortic stenosis, Black patients had a statistically significant decreased incidence of TAVR when compared to White patients (2513 versus 3805; IRR, 0.66; 95% CI, 0.56–0.77; P<0.001). Hispanic patients admitted with aortic stenosis had an incidence of TAVR of 3553, however, there was no statistically significant difference when compared to White or Black patients. The study concluded that there are racial inequities in the surgical treatment of aortic stenosis. However, further research is needed to further elucidate the causes of such inequities so that systemic changes can be implemented in an effort to reduce the disparities.

Click to read the study in JAHA

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