Abstract 14838: Diagnostic Referral Biases Affect Black and Female Patients With Severe Aortic Stenosis

Abstract

Introduction: The role of racial and socioeconomic factors, using the novel distressed communities index (DCI), on referral patterns in patients with severe aortic stenosis (AS) is poorly characterized. Hypothesis: Non-White patients are less likely to be referred for possible aortic valve intervention (AVI). Methods: Between January 1, 2010 and December 31, 2019 all adult patients with evidence of severe AS on echocardiogram were identified. Patients with prior aortic valve replacement were excluded. Referral and non-referral were determined in the electronic medical record (EMR) up to 14 days after index echocardiogram. In absence of referral, patients who died within 14 days were excluded. All patients were included in a multivariate logistic regression model of non-referral to adjust for statistically significant differences in age, sex, pre-existing medical comorbidities, DCI score, and AS hemodynamics. Results: Of the 179,483 patients identified, 1535 met inclusion criteria for the study. The overall mean age was 80.2 years (95% CI [79.6-80.8]) and was composed of White/Caucasian (50.7%), Black/African American (17.9%), Hispanic/Latino (26.1%), Asian (2.8%), and majority female (58.5%) patients. Female (OR 1.442, 95% CI [1.113-1.866] and Black (OR 1.468, 95% CI [1.023-2.106]) patients faced referral disparities, in spite of adjustment for advanced age (OR 3.739, 95% CI [2.556-5.470]) and dementia (OR 3.114, 95% CI [2.053-4.722]). Pre-existing stroke was collinear with dementia and excluded. In contrast, patients with history of coronary artery disease and those who were evaluated after initiation of the electronic medical record were more likely to be referred. Conclusions: When adjusted for medical comorbidities and socioeconomic factors, Black and female patients were less likely to be referred for possible AVI. Additional studies are required to characterize disparities at other levels of healthcare utilization.