Abstract 18205: Ethnicity and Aortic Stenosis: Presentation, Management and Outcomes

Abstract

Background: Ethnic disparities exist in the diagnosis and management of aortic stenosis (AS), including decreased rates of transcatheter aortic valve implantation (TAVI) in Black patients. We sought to identify if disparities persist in the setting of universal healthcare and whether they are affected by social deprivation. Methods: A validated natural language processing pipeline was applied to the electronic health records of >1M patients at King’s College Hospital (UK) to identify 6214 patients with AS (4.5% Asian, 7.6% Black, 87.9% White self-reported ethnicity). All analyses are adjusted for age and social deprivation. Results: Black and Asian patients had more comorbidities (P<0.05), while Black patients had more cardiac symptoms compared to White patients (P<0.05). Mean time from first report of breathlessness to AS diagnosis was 2.61 years for Asian patients, 2.93 years for Black patients, and 2.09 years for White patients (P<0.05). For those with severe AS, TAVI was performed in 14.3% of Asian patients, 14.3% of Black patients, and 20.2% of White patients. The mean time from severe AS diagnosis to TAVI was 0.41 years for Asian patients, 0.88 years for Black patients, and 0.52 years for White patients (P= NS). Surgical aortic valve replacement (AVR) was performed in 12.5% of Asian patients, 15.5% of Black patients, and 15.4% of White patients. The mean time to AVR was longer for Black patients (1.07 years) compared to Asian (0.19 years) and White patients (0.35 years, P<0.05). The mortality benefit of TAVI or AVR interventions was similar between race and ethnicity groups in a Cox multivariate analysis. Conclusions: Ethnicity-based differences exist in the presentation, diagnosis and management of AS, despite correction for social deprivation. Further, Black patients with severe AS are less likely to receive TAVI intervention, and wait significantly longer for AVR, despite similar efficacy. These data should stimulate strategies to address inequity.