Temporal trends in transcatheter aortic valve replacement use and outcomes by race, ethnicity, and sex.

Abstract

ObjectivesTo identify trends in transcatheter aortic valve replacement (TAVR) use and outcomes by race (non‐Hispanic White, Black), ethnicity (Hispanic), and sex over time.BackgroundDespite rapid growth in TAVR use over time, our understanding of its use and outcomes among males and females of underrepresented racial/ethnic groups remains limited.MethodsA retrospective analysis of hospitalizations from 2013 to 2017 from the Healthcare Cost and Utilization Project database was performed.ResultsWhite patients comprised 65% (n = 2.16 × 107) of all hospitalizations, yet they comprised 83% (n = 176,887) of the admissions for aortic stenosis (p < 0.0001). Among 91,693 hospitalizations for aortic valve replacement, 64,069 were surgical (34.0% female, 7.0% Hispanic, and 5.9% Black) and 27,624 were transcatheter (46.6% female, 4.5% Hispanic, and 4.4% Black). Growth in TAVR volumes was the slowest among minorities and females. Hispanic males, Hispanic females, and White females had the highest in‐hospital mortality (2.7%–3.3%; compared to White males, adjusted odds ratio: Hispanic males 1.9 [1.2–3.0], Hispanic females 1.9 [1.2–3.1], and White females 1.4 [1.2–1.7]). Despite less baseline vascular disease, females of all races/ethnicities had more vascular complications than men (female 5% vs. male 3.5%, p ≤ 0.001). Further adjustment for vascular complications only partially attenuated mortality differences. Black and Hispanic patients had a longer mean length of hospital stay than White patients, which was most pronounced among females. Pacemaker requirements were consistently low among all groups.ConclusionDifferences in TAVR growth and outcomes by race, ethnicity, and sex over time highlight areas for focused efforts to close gaps in minimally invasive structural heart disease care.