Abstract 15832: Racial Differences in the Utilization and Outcomes of Transcatheter Aortic Valve Replacement

Abstract

Introduction: The use of transcatheter aortic valvular replacement (TAVR) improves outcomes in patients with aortic stenosis (AS). However, there is limited data describing racial disparities in TAVR use. Our aim was to evaluate outcomes according to racial groups and TAVR use in the national inpatient sample (NIS). Methods: We identified all patients undergoing TAVR between 2016 - 2020 from the NIS of the Health Care Utilization Project database. Patients were classified according to ethnic groups as white, black, Hispanic, and Asians. Outcomes included TAVR utilization by ethnic group, mortality, respiratory failure rates, cardiogenic shock, cardiac arrest, and hospital length of stay (H-LOS). Multivariate analysis was performed adjusting for age, sex, cardiovascular comorbidities, and socioeconomic status. Results: From 296,740 patients who underwent TAVR, 89.5% were white, 4.24% were black, 4.9% were Hispanic, and 1.39% were Asian. Blacks had higher rates of CHF, chronic kidney disease, peripheral vascular disease, obesity, and anemia but lower rates of myocardial infarction, CABG, pacemaker placement and PCI. Hispanic patients showed higher rates of AKI, while Asian patients had higher rates of DM. Blacks had lower adjusted mortality rates compared to whites (aOR: 0.56; CI 0.35 - 0.88 p=0.014). Respiratory failure rates (aOR: 0.82; CI 0.68 - 0.98, p=0.031) and H-LOS (5.2 days vs 3.7 days) were higher in black patients. Whites had a steeper increase in TAVR use compared to other groups during the study period. Patients with AS undergoing TAVR had significant lower adjusted mortality (aOR: 0.95; CI 0.92 - 0.98 p=0.005). Conclusion: White patients are most likely to receive TAVR compared to other ethnic groups. Such differences in TAVR utilization by ethnic group should be studied further to decrease healthcare disparities