Black Patients Research Articles

Heparin-induced thrombocytopenia (HIT) is a life-threatening immunologic reaction to heparin exposure that is associated with substantial morbidity and mortality. Limited research is available on host-dependent risk factors, such as age, gender, and ethnicity. This study aims to characterize any association between age, gender, ethnicity, and mortality in HIT patients to better identify patient populations at increased risk. This is a retrospective case control analysis of all-cause mortality in 72,935 patients with a diagnosis of HIT between 2016 and 2020. Adult patients with HIT were selected using the ICD-10 code D75.82 (HIT) for inclusion and evaluated by demographic, clinical, and hospital characteristics. Odds ratios were calculated for continuous variables using 95% confidence intervals. Multivariable logistic regression was used to ascertain the odds of binary clinical outcomes relative to patient and hospital characteristics as well as the odds of clinical outcomes over time. Our analysis indicates that hospitalized patients with HIT are at 5 times higher odds of mortality than those without HIT (OR: 5.42, 95% CI: 5.15-5.71, p < 0.001). Our data also indicates significantly higher odds of HIT-associated mortality based on patient age, gender, and ethnicity. By age, HIT patients at the highest risk of mortality were found to be between ages 46 and 60 (odds ratio (OR): 2.60, 95% CI: 1.58-4.25, p < 0.001). By gender, females with HIT are at significantly lower odds of mortality compared to males (OR: 0.90, 95% CI: 0.82-0.99, p < 0.001). By ethnicity, Hispanic patients are at the highest risk of mortality (OR: 1.52, 95% CI: 1.31-1.77, p < 0.001), followed by Black patients (OR: 1.45, 95% CI: 1.27-1.66, p < 0.001), and then Asian patients (OR: 1.31, 95% CI: 1.00-1.72, p = 0.05). HIT remains a clinical diagnosis based on quantitative criteria such as thrombocytopenia relative to baseline and timing of platelet decline but does not take into consideration other clinical variables that may stratify patients by increased risk. This study elucidates the relationship between host-dependent risk factors such as age, gender, and ethnicity on the risk of all-cause mortality associated with HIT.

We conducted a retrospective analysis of elderly stage I-III non-small cell lung cancer (NSCLC) in the hope of providing more evidence for adjuvant chemotherapy in elderly NSCLC patients. Data from NSCLC patients ≥ 70 years of age during 2010-2015 from the Surveillance, Epidemiology, and End Results database were used to analyze the data. Patients were divided into chemotherapy and non-chemotherapy groups. Propensity score matching was performed to construct a balanced cohort of chemotherapy and non-chemotherapy. Data from the matched 2 groups were subjected to Kaplan-Meier analysis, and multivariate COX regression analysis was performed to evaluate the effect of chemotherapy on overall survival. Subgroup analyses were performed to determine the specific benefit population. A total of 18,126 eligible patients were enrolled in the study. Among these, 4776 patients (26.35%) received chemotherapy, while 13,350 patients (73.65%) did not. Utilizing propensity score matching, 6974 patients were successfully matched, achieving baseline equilibrium between the chemotherapy and non-chemotherapy groups. In the matched dataset, multivariate Cox regression analysis indicated a 26% reduction in the risk of mortality for the chemotherapy group compared to the non-chemotherapy group (hazard ratio = 0.74, 95% confidence interval = 0.70-0.78, P < .001). Furthermore, Kaplan-Meier analysis of the matched data demonstrated a survival advantage for the chemotherapy group relative to the non-chemotherapy group, with a statistically significant difference observed. Additionally, subgroup analyses revealed that specific demographics, including Black patients, those with higher grades of tumor differentiation, and patients classified as stage II-III, T2-T3, and N1-N2, were more likely to benefit from chemotherapy. Through the findings of this study, it was demonstrated that chemotherapy can enhance the prognosis of elderly patients with NSCLC. This is particularly evident in patients who are Black, possess a high tumor cell grade classification, are in advanced stages of the disease, and exhibit multiple peripheral lymph node metastases, as they are likely to derive significant benefits from this treatment.

This study examined receipt of three components (screening, risk assessment, and intervention) of the national Zero Suicide model among patients of various races-ethnicities who were treated in six large health systems. The data included outpatient psychiatry and addiction medicine visits (N=4,682,918) during 2019 for patients age 13 and older. Documentation in the electronic health record of administration of the nine-item Patient Health Questionnaire, the Columbia-Suicide Severity Rating Scale, and lethal means counseling and provision of crisis resources (with or without a full Stanley-Brown Safety Plan) were used to define having received suicide screening, risk assessment, and intervention, respectively. After adjustment for age, sex, and health system, analyses indicated that Black patients were 12%-20% less likely (odds ratio [OR] range 1.12-1.20), and Asian patients were 5%-15% more likely (OR range 1.05-1.15), to be screened for suicidal ideation compared with patients of other races-ethnicities. Compared with White patients, patients of other races-ethnicities were found to be more likely (OR range 1.08-1.24) to receive risk assessment, and Asian and Black patients were found to be 17% (95% CI=1.02-1.35) and 15% (95% CI=1.01-1.32) more likely, respectively, to receive an evidence-based intervention for suicide prevention. American Indian/Alaska Native (AI/AN) patients had the lowest unadjusted rates of receiving an intervention (65.8%). The adjusted analyses suggested that more focus is needed on population-based screening for suicidal ideation and to improve delivery of evidence-based interventions for suicide prevention among White patients. The descriptive findings suggest that more research is needed to improve intervention delivery to AI/AN patients at risk of suicide.

Racial and/or Ethnic and Rural Disparities in Health Care Utilization Before Major Lower Extremity Amputation in Patients with Peripheral Artery Disease.

Introduction Sepsis-related mortality in middle-aged and older pancreatic cancer patients constitutes a significant public health issue. This study seeks to analyze trends in the age-adjusted mortality rate (AAMR) for sepsis-related fatalities among these patients in the United States from 1999 to 2023, employing data from the most recent CDC WONDER database. The temporal patterns revealed from this analysis are anticipated to guide subsequent research and public health initiatives. Methods The CDC WONDER database was used to look at how many middle-aged and older pancreatic cancer patients in the U.S. died from sepsis between 1999 and 2023. The study utilized AAMR to evaluate temporal mortality patterns among adults aged 45 and older, categorized by race, census region, urban/rural residency, and state, using the Joinpoint regression tool. We calculated the annual percent change (APC) and the average annual percent change (AAPC), and we supplied 95% confidence intervals. Results During the study period, the sepsis-related death rate among middle-aged and elderly pancreatic cancer patients exhibited a notable increase, with an AAPC of 2.89. Male patients consistently demonstrated a greater AAMR compared to females, with a notable increase recorded [AAPC = 2.73 (95% CI 1.61 to 3.87)]. Black or African American patients had the greatest AAMR, which also went up a lot [AAPC = 2.62 (95% CI 1.76 to 3.48)]. The mortality burden increased significantly with age, reaching its highest point in the 75–84 age range. A regional study found that the Midwest had the highest rise in AAMR [AAPC = 3.74 (95% CI 2.50 to 5.00)]. Urban people consistently exhibited a higher AAMR compared to rural communities, despite the most significant increase in AAMR occurring among rural populations [AAPC = 3.51 (95% CI 2.09 to 4.94)]. Conclusion This study’s findings reveal substantial inequalities among gender, ethnicity, age, and geographic regions. These differences show how important it is to quickly implement targeted measures to lower mortality, especially among individuals at high risk.

Introduction: There are concerns that renin-angiotensin system inhibitors are less effective in Black patients than non-Black patients with heart failure (HF). We have tested whether this concern might also apply to mineralocorticoid-receptor antagonists (MRAs). Objectives: We examined the efficacy and safety of MRAs, compared with placebo, in patients with HF and reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF), according to race (Black or non-Black). Methods: We conducted an individual-participant data meta-analysis of the 4 major randomized controlled trials comparing MRAs to placebo in patients with HFrEF (RALES, EMPHASIS-HF) and HFpEF (TOPCAT, FINEARTS-HF). Race was self-reported. The primary outcome was a composite of cardiovascular death or first HF hospitalization. Results: Of the 13,846 patients randomized in the four trials, 577 (4.2%) identified as Black (4.3% in the HFrEF trials; 4.1% in the HFpEF trials). Rates of HF hospitalizations and death were higher in Black than non-Black patients. The hazard ratio (HR) for MRA versus placebo for the primary composite outcome was 0.87 (95% CI, 0.66-1.15) in Black patients and 0.77 (95% CI, 0.72-0.82) in non-Black patients (P interaction =0.34) (Figure) . For first HF hospitalization, the HRs were 0.86 (95% CI, 0.63-1.17) and 0.73 (95% CI, 0.68-0.80) for Black and non-Black patients, respectively (P interaction =0.36). The corresponding HRs for cardiovascular death were 0.75 (95% CI, 0.48-1.17) and 0.81 (95% CI, 0.74-0.90) respectively (P interaction =0.80). For cardiovascular death and total HF hospitalizations, the corresponding rate ratios were 0.80 (0.61-1.06) and 0.76 (95% CI, 0.71-0.82), respectively (P interaction =0.96). Adverse events with MRAs, compared with placebo, including hypotension, elevated creatinine, hyperkalemia, and hypokalemia were not modified by race. Findings were similar when the population was restricted to patients randomized in the Americas only. The effects of MRAs in patients with HFrEF and HFpEF, individually, were not modified by race (Figure) . Conclusions: The beneficial effects of MRAs, compared with placebo, on clinical events were comparable in Black and non-Black patients with HF, regardless of HF phenotype.

Background: We do not clearly understand racial differences in risk profile, cardiac echocardiographic metrics among mitral valve prolapse (MVP) patients neither are differences in long-term outcome well characterized. Objective: To assess the association between race, echocardiographic parameters, and clinical outcomes among MVP patients. Methods: Baseline demographics, self reported race, echocardiographic data, medication use, and cardiovascular and medical comorbidities were evaluated for white and black patients with echocardiographic evidence of MVP (n=7751) at a large multi-hospital academic health system between 2010-2024. Patients with mitral and aortic valve procedures, mitral or aortic stenosis, infiltrative cardiomyopathies, HCM, EF&lt;35%, and cancer were excluded. Long term outcomes regarding all-cause mortality, cardiovascular (CV) hospitalization for heart failure (HF), atrial fibrillation (AF), stroke and ventricular tachycardia/fibrillation/sudden cardiac arrest (VT/VF/SCA) were evaluated along with cardiac interventions. Multivariable Cox proportional hazard modeling was performed to impact of race on mortality and CV hospitalization. Results: Although black (n=438, 5.6%) patients with MVP were younger (57±2 vs. 62.4±2,P&lt;0.001), they had more cardiovascular risk factors (diabetes (17% vs 7%, p&lt;0.001), hypertension (53% vs 40%, p&lt;0.001) chronic kidney disease (8% vs 3.4%, p&lt;0.001)), higher comorbidity burden (Charlson Comorbidity Index 1.3±1.7 vs 0.73±1.1, p&lt;0.001). Black patients had predominantly anterior MVP involvement (55% vs 29%) and less severe MR at presentation but had lower EF (10% with 35-50% EF) and increased pulmonary artery systolic pressures across age spectrum (Figure 1,2). Black patients experienced significantly increased comorbidity adjusted all-cause mortality (HR 1.2, CI 1-1.5, p=0.05) and CV hospitalizations (HR 1.36, CI1.1-1.6, p=0.003) particularly related to HF and VT/VF/SCA (Figure 2). However, black patients were less likely to undergo surgical mitral valve repair or ICD implantation (Figure 3). Conclusion: Significant racial differences in disease expression, clinical outcomes and healthcare utilization exist between white and non-white mitral valve prolapse patients. Further research is needed to understand valvular phenotype and treatment gaps in MVP patients across racial and ethnic groups to improve outcomes.

Introduction: ST-segment elevation myocardial infarction (STEMI) requires urgent intervention, yet significant disparities in outcomes persist. While sex and racial/ethnic disparities in STEMI mortality are documented, and socioeconomic status (SES) is a known predictor, the independent impact of sex, race/ethnicity, and SES on key in-hospital outcomes (mortality, length of stay [LOS], total charges) within a large, contemporary national cohort remains incompletely characterized. Methods: We analyzed the National Inpatient Sample (NIS)(2018-2022) for adults with STEMI. Van Walraven Weighted Elixhauser Comorbidity index was used to survey linear and logistic regression models with 38 covariates to assess associations between sex, race (White [reference], Black, Hispanic, Asian), national income quartiles (lowest quartile [reference]), and in-hospital outcomes: mortality, length of stay (LOS), and total charges. Results: Among 1,013,435 adults with STEMI, significant disparities emerged. Females (OR:1.24; 95%CI:1.20-1.29; p&lt;0.001), Black (OR:1.10; 95%CI:1.04-1.17; p=0.01), Hispanic (OR:1.15; 95%CI:1.08-1.22; p&lt;0.001), and Asian patients (OR:1.10; 95%CI:1.002-1.2001; p=0.04) showed higher mortality odds versus males and Whites, respectively. Higher income quartiles had lower mortality odds: second lowest quartile (OR:0.90; 95%CI:0.86-0.95; p&lt;0.001), second highest (OR:0.83; 95%CI:0.78-0.87; p&lt;0.001), highest quartile (OR:0.77; 95%CI:0.73-0.81; p&lt;0.001). Females had shorter LOS (β:-0.09 days; 95%CI:-0.16 to -0.03; p&lt;0.001), while Black (β:0.32 days; 95%CI:0.19-0.45; p&lt;0.001) and Hispanic patients (β:0.37 days; 95%CI:0.26-0.50; p&lt;0.001) had longer LOS. Total charges were lower for females (β:-$11,326; 95%CI:-$13,161 to -$9,490; p&lt;0.001) and Black patients (β:-$4,623; 95%CI:-$8,357 to -$889; p=0.01), but higher for Hispanics (β:$25,796; 95%CI:$21,177-$30,417; p&lt;0.001) and Asians (β:$8,711; 95%CI:$2,047-$15,377; p=0.01). Income quartiles did not predict LOS or charges (all p&gt;0.05). Conclusion: Significant sex, racial, and income-based disparities persist in STEMI mortality, hospitalization duration, and costs, underscoring urgent needs for equity-focused interventions.

Background: The wearable cardioverter-defibrillator (WCD) is a an external, patient-controlled device that offers lifesaving protection against sudden cardiac death in patients with contraindications to immediate implantable cardioverter-defibrillator (ICD) placement. Racial disparities in cardiovascular care are well documented, with Black patients undergoing invasive procedures at lower rates than White patients, despite similar or higher disease burdens. These disparities may partly reflect patient preferences, as studies show that Black patients have greater aversion to invasive treatments. We therefore hypothesized that Black patients would have a higher utilization of WCD therapy compared to White patients. Methods: We analyzed discharge encounters from the National Inpatient Sample (2016-2020) for patients with clinical indications for implantable cardioverter-defibrillator placement who did not receive the device during hospitalization. Survey-weighted logistic regression estimated odds of WCD discharge. Results: Among 3,298,524 patients eligible for WCD at discharge, 71% were White and 16% were Black. Only 0.26% of these were discharged with WCD. In multi-variable analysis adjusting for demographics, co-morbidities, and hospital characteristics, Black patients remained 79% more likely to receive WCD (adjusted OR 1.79, 95% CI 1.59-2.01, p&lt;0.001). Hispanic patients had 22% higher odds (OR 1.22, CI 1.04-1.43, p=0.01). Male gender, larger hospitals, and urban teaching centers were independently associated with increased WCD use. Adjusted predicted probabilities of WCD at discharge from 2016 to 2020 revealed that Black patients had the highest probability of getting WCD, with a steady increase over the 5-year period. Conclusions: A higher proportion of ICD-eligible Black patients received WCD compared to Whites. This supports our hypothesis and may be additional evidence that Black patients tend to prefer less invasive interventions. Given that WCD effectiveness is critically dependent on continuous adherence and that racial disparities in medical device adherence are well-documented, these patients may face excess risk of sudden cardiac death during the vulnerable period when relying on WCD protection. Further research should investigate targeted interventions to improve adherence and examine whether the preference for WCD over ICD compromises survival outcomes in Black patients.

Background: Racial disparities in health outcomes are well-documented, yet their impact on major adverse cardiovascular and cerebrovascular events (MACCE) in patients with dementia remains insufficiently explored. This study examines racial differences in MACCE outcomes using data from the National Inpatient Sample (NIS) from 2016 to 2021. Methods: A retrospective cohort study was conducted utilizing NIS data, focusing on patients with dementia. Multivariate logistic regression was employed to adjust for potential confounders, analyzing the odds ratios for various MACCE outcomes across different racial groups. Results: The cohort included 9,195,501 White patients, 1,704,025 Black patients, 1,018,515 Hispanic patients, 327,035 Asian or Pacific Islander patients, 48,815 Native American patients, and 314,090 patients identified as Other. The mean ages were 80.5 years for White, 76.8 years for Black, 78.8 years for Hispanic, 81.1 years for Asian or Pacific Islander, 74.9 years for Native American, and 78.8 years for Other patients. Black patients exhibited higher odds of sudden cardiac death (OR 1.77, 95% CI 1.71–1.83, p &lt; 0.0001) and were more likely to require dialysis (OR 2.75, 95% CI 2.61–2.91, p &lt; 0.0001). Hispanic patients showed increased odds for sudden cardiac death (OR 1.40, 95% CI 1.34–1.47, p &lt; 0.0001) and intracranial hemorrhage (OR 1.23, 95% CI 1.18–1.28, p &lt; 0.0001). Asian or Pacific Islander patients had higher odds of sudden cardiac death (OR 1.65, 95% CI 1.54–1.77, p &lt; 0.0001) and were less likely to experience heart block (OR 0.73, 95% CI 0.70–0.77, p &lt; 0.0001). Notably, Native American patients had increased odds of requiring dialysis (OR 2.11, 95% CI 1.65–2.70, p &lt; 0.0001) but did not show statistically significant differences for sudden cardiac death. Conclusion: This study highlights significant racial disparities in MACCE outcomes among dementia patients, with Black, Hispanic, and Asian or Pacific Islander patients demonstrating elevated risks for specific cardiovascular events compared to their White counterparts. These findings emphasize the need for targeted, culturally sensitive interventions to address the underlying factors contributing to these disparities in cardiovascular health among dementia patients. Future research should explore the mechanisms driving these differences to inform improved clinical practices and policies.

Background: The efficacy of tafamidis treatment in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) is well known, as supported by findings in the ATTR-ACT trial. However, to our knowledge, no study has investigated the racial implications on the economic effects of tafamidis tied to heart failure (HF) outcomes by using each patient as their own control. Hypothesis: Racial disparities lead to delayed diagnosis and treatment, resulting in a reduced benefit of tafamidis for decreasing costs associated with HF admissions in Black patients. Methods: We conducted a retrospective pre-post study of 186 ATTR-CM patients on tafamidis, stratified by race and amyloid subtype. Each patient served as their own control. The primary outcome was healthcare cost savings (using our institutional cost of $2,920/hospital day). Secondary outcomes included total HF admissions and length of stay (LOS) during 90 days pre- and post-tafamidis. We compared baseline NYHA class distribution between racial groups and analyzed treatment responses across hereditary (hATTR-CM) versus wild-type (wtATTR-CM) subtypes. Statistical analysis used Mann-Whitney U tests for inter-group comparisons and Wilcoxon signed-rank tests for pre-post outcomes. Results: Black patients had a median reduction in LOS of 7.5 days, compared to 3.5 days for White patients, leading to cost savings of $21,900 versus $10,220 (Figure 1). Total hospital admissions and LOS were higher for Black patients across NYHA classes II and III (Figures 2 and 3). At tafamidis initiation, Black patients had a higher baseline NYHA class (mean 2.50 vs 2.13, p=0.010). There was no significant difference in treatment delay from diagnosis, with Black patients experiencing a median delay of 68.5 days compared to 62.5 days (p=0.169). Additionally, the mean reduction in LOS did not differ among Black hATTR-CM (n=10), Black wtATTR-CM (n=7), and White wtATTR-CM (n=14) groups, with reductions of 4.70 days, 5.43 days, and 3.21 days, respectively (p=0.211). Conclusion: Black patients presented with more advanced disease but achieved greater absolute benefits and cost savings from tafamidis. With no treatment delays, later presentation likely reflects disparities in diagnosis and healthcare access, resulting in higher pre-treatment costs that resolved with appropriate therapy. These findings underscore the need for early diagnosis and equitable specialist access, while confirming universal tafamidis efficacy across diverse populations.

Background: Chemotherapy is associated with increased cardiovascular risk in breast cancer patients, yet the influence of racial and ethnic disparities on atrial fibrillation (Afib) and cardiomyopathy outcomes remains understudied. Hypothesis: Chemotherapy increases Afib and cardiomyopathy risk in breast cancer patients, with older age, pre-existing cardiac risk, and racial/ethnic differences (particularly among Black and Hispanic patients) contributing to differential risk profiles. Methods: We analyzed 1,193 female breast cancer patients from the All of Us workbench dataset who received chemotherapy and developed cardiovascular diseases, including Afib ( n =723) or cardiomyopathy ( n =284). Firth-corrected Cox proportional hazards models (penalizer=0.5) assessed the effects of age, pre-existing cardiac risk, race (White, Black, Asian, Other), ethnicity (Hispanic vs. non-Hispanic), and age group (&lt;65 vs. ≥65 years) on time to Afib or cardiomyopathy. Results: Age significantly increased Afib (HR=1.01, 95% CI: 1.01-1.02, P&lt;0.005) and cardiomyopathy risk (HR=1.02, 95% CI: 1.01-1.03, p =0.002). Pre-existing cardiac risk showed non-significant trends for Afib (HR=1.09, 95% CI: 0.98-1.21, p =0.098) and cardiomyopathy (HR=1.12, 95% CI: 0.95-1.32, p =0.17). Black patients ( n =189) had higher Afib incidence (4.8%) than White patients ( n =762, 3.2%), with stronger cardiac risk effects (HR=1.25, 95% CI: 1.02-1.53, p =0.03). Hispanic patients ( n =231) had lower Afib incidence (2.9%) than non-Hispanic patients (3.7%). Patients ≥65 years ( n =524) had elevated Afib risk (HR=1.15, 95% CI: 1.05-1.26, p =0.003). Conclusion: Older age and Black race are associated with increased Afib risk post-chemotherapy, while Hispanic patients may have lower risk. These findings highlight the need for targeted cardio-oncology interventions to address disparities.

Introduction: Pharmacy deserts, areas where residents lack nearby access to pharmacies, are a structural barrier to healthcare. Prior work has documented racial disparities in pharmacy access using census tracts, but such static measures do not capture accessibility metrics such as neighborhood walkability. Here, we introduce a novel geospatial method using 15-minute walking distances around active pharmacies to more precisely define pharmacy deserts (Figure 1). We then examine disparities in cardiometabolic control across racial groups in a large urban health system. Hypothesis: We hypothesized that living in a pharmacy desert is associated with worse cardiometabolic outcomes, and that this relationship varies by race. Methods: We conducted a cross-sectional analysis of Cardiology and Primary Care clinic patients at an urban tertiary care center between January 1, 2019, and December 31, 2023. We then modeled the odds of uncontrolled blood pressure (BP) and HbA1c by pharmacy desert residence in a case-control framework. Pharmacy data was obtained from the Chicago Data Portal and 15-minute walking distances were generated using Mapbox API. Patients living &gt;15-minutes from a pharmacy were classified as living in a pharmacy desert. We used multivariable logistic regression to model uncontrolled BP (≥140/90 mmHg) and uncontrolled HbA1c (≥7.0%), adjusting for age, sex, and race, and testing for racial effect modification. Results: Among 20,504 patients with BP data, pharmacy desert residence was associated with higher odds of uncontrolled BP (OR = 1.11, p = 0.006). This association was significant among White patients (OR = 1.44, p = 0.001) but not Black patients (OR = 1.07, p = 0.13). A similar pattern was seen for HbA1c (N = 1,346): White patients had significantly higher odds of uncontrolled HbA1c in pharmacy deserts (OR = 2.93, p = 0.03), but Black patients did not (OR = 1.04, p = 0.79). Notably, Black patients had markedly worse control overall compared to white patients (BP OR = 2.11, p &lt; 0.001; HbA1c OR = 1.60, p = 0.03), regardless of pharmacy access. Conclusion: Pharmacy deserts are linked to worse cardiometabolic outcomes for White patients, but this association is absent among Black patients, who consistently show poorer outcomes regardless of proximity to a pharmacy. These results suggest other factors may blunt the benefits of geographic proximity to a pharmacy among some racial groups.

Background: Transcatheter aortic valve replacement (TAVR) is a groundbreaking therapy for the management of severe aortic stenosis. Racial disparities in cardiovascular care including aortic stenosis however remain prevalent. Our study aims to investigate national trends in TAVR utilization and inpatient outcomes by race. Methods: We conducted a retrospective analysis of TAVR procedures from 2016 to 2021 using the NIS database. Patients were categorized by race (White, Black, Hispanic, Asian). Trends in TAVR utilization were evaluated using adjusted predicted probabilities. In-hospital outcomes, including mortality, acute kidney injury (AKI), myocardial infarction (MI), stroke, major bleeding, mechanical complications(breakdown, displacement, leakage) and cardiac arrest were compared using multivariable logistic regression, adjusting for age, sex, insurance, comorbidity index, income, and region. Results: A total of 319,085 TAVR procedures were identified from 2016–2021 (White: 286,265; Black: 13,070; Hispanic: 15,355; Asian: 4,395). While TAVR utilization increased across all racial groups during the study period, the adjusted predicted probability of undergoing TAVR was consistently highest for White patients and lowest for Black patients. After multivariable adjustment, Hispanic patients had significantly higher odds of inpatient mortality (aOR 1.68;95%CI 1.28–2.21), AKI (aOR 1.42;95%CI 1.21–1.66), and MI (aOR 1.45;95%CI 1.16–1.81) compared to White patients. Black patients had higher odds of AKI (aOR 1.25;95% CI 1.09–1.43). No significant differences were observed for stroke, major bleeding, mechanical complications, or cardiac arrest among the racial groups after adjustment. Conclusion: Despite an overall increase in TAVR utilization, there remains significant racial disparities in both access to and outcomes of TAVR in the US. Black patients were noted to have the lowest rates of TAVR utilization. Hispanic patients experienced significantly higher adjusted odds of inpatient mortality, AKI, and MI, while Black patients also had higher odds of AKI during the study period. These findings highlight the need for focused interventions aimed at addressing underlying factors contributing to these disparities and ensuring equitable TAVR use.

Introduction: Hypertension (HTN) is a major contributor to both heart disease and stroke, with a prevalence of 48%. While Black patients have a higher prevalence of HTN than their White counterparts, they also experience lower overall control rates, making them a high-risk group for complications related to HTN. Self-monitored blood pressure (SMBP) programs are interventions where patients use at-home devices to track their blood pressure and can be effective at improving control. Research Questions: The Ohio State University Total Health Care Center sought to improve HTN control rates, especially among non-Hispanic Black patients by implementing an SMBP program. Methods: Patients with HTN were referred to the SMBP program by their Primary Care Provider (PCP). Enrollment consisted of a 60 minute education session with an RN, where a personalized HTN care plan was developed, bluetooth blood pressure cuff and apps were setup, and patients received education for lifestyle modifications aimed at reducing blood pressure. After enrollment, PCPs would receive bi-weekly readings through the EMR and schedule a follow-up appointment within 30 days. A multidisciplinary approach was taken, where patients could receive care from a pharmacist, a dietitian, a counselor, or community health worker. Results: HTN control rates overall in the Health Center increased over time (58.08% in 2020 to 66.14% in 2023). Patients enrolled in SMBP had significantly higher control rates (77.78% vs.66.14%) than patients not enrolled in SMBP. Black patients enrolled in the SMBP program had higher control rates (74.38%) than White patients not participating in the SMBP program (72.73%), eliminating the racial disparity. When classified according to very low engagement (&lt;5 readings), low engagement (6-19), moderate engagement (20-39), and high engagement (&gt;40), the very low engagement group had the lowest control rates (69.05%) and steadily increased with engagement (84.38%, 86.36%, and 86.96%, respectively). Conclusion: Implementation of an interdisciplinary approach was effective in creating a successful SMBP program. Patients enrolled in SMBP had significantly higher control rates than patients not enrolled. Control rates increased with more engagement, peaking at moderate engagement and plateauing after that. Control rates increased significantly for Black patients, even exceeding that of white patients SMBP can be an effective strategy for eliminating racial disparities for hypertension control.

Introduction: Cytochrome P450 2C19 ( CYP2C19 ) loss-of-function (LOF) genotypes reduce clopidogrel, but not prasugrel or ticagrelor, effectiveness following percutaneous coronary intervention (PCI). Accumulating evidence has demonstrated the clinical benefit of using CYP2C19 genotype to guide selection of P2Y12 inhibitor therapy after PCI. However, these studies have primarily included patients of European and East Asian ancestry. Therefore, there is a paucity of data on the impact of CYP2C19 -guided antiplatelet therapy on clinical outcomes in Black patients. Aim: We aimed to assess the impact of CYP2C19 -guided P2Y12 inhibitor selection on risk for major atherothrombotic events (MAE) among self-reported Black patients within one-year post-PCI. Methods: Black adults across five institutions who underwent PCI and clinical CYP2C19 genotyping for LOF alleles and were prescribed clopidogrel or an alternative P2Y12 inhibitor (prasugrel, ticagrelor) were included. The ultimate prescribing decision was at the prescriber’s discretion. Atherothrombotic events were manually abstracted from the electronic health record and adjudicated. The primary outcome, MAE (composite of all-cause mortality, myocardial infarction, ischemic stroke, stent thrombosis, or unstable angina requiring revascularization), was compared between patients treated with alternative P2Y12 inhibitors (irrespective of CYP2C19 status) versus LOF allele carriers treated with clopidogrel, and separately versus non-LOF carriers treated with clopidogrel, using multivariable Cox regression. Results: The study population consisted of 1,244 Black patients (mean age 61±12 years; 44% women; 70% with acute coronary syndrome), with 734 patients prescribed clopidogrel (170 LOF-carriers, 564 non-LOF-carriers) and 510 prescribed an alternative inhibitor. MAE rates were higher in the LOF-clopidogrel vs alternative inhibitor group (29.1 vs . 13.9 events per 100 PY; unadjusted HR: 0.49 [95%CI: 0.31-0.77], p=&lt;0.01; adjusted HR: 0.54 [95%CI: 0.32-0.91], p=0.02). MAE rates did not differ between the non-LOF-clopidogrel and alternative inhibitor groups (15.4 vs. 13.9 events per 100PY; unadjusted HR: 0.99 [95% CI:0.61-1.32], p=0.57; adjusted HR: 0.99 [95% CI:0.65-1.50], p=0.97). Conclusion: These data suggest that clopidogrel is as effective as alternative P2Y12 inhibitors in post-PCI Black patients without a CYP2C19 LOF allele, while alternative therapy improves outcomes in LOF allele carriers.

Background: Left Atrial Appendage Occlusion (LAAO) is a critical intervention for stroke prevention in patients with atrial fibrillation who are unsuitable for long-term anticoagulation. Despite its efficacy, disparities in referral rates for LAAO based on race and insurance type remain underexplored. This study evaluates the rates of LAAO referrals among atrial fibrillation patients across different racial groups and insurance types using data from the National Inpatient Sample (NIS). Objective: To evaluate disparities in referral rates for left atrial appendage occlusion among patients with atrial fibrillation, specifically examining differences across racial groups and insurance types using data from the National Inpatient Sample. Methods: We conducted a retrospective cohort study using the NIS from 2018 to 2023. Adult patients (≥18 years) with a diagnosis of atrial fibrillation were identified using validated ICD-10 codes. Patients were stratified by race (White, Black, Hispanic, Asian) and primary payer type (Private Insurance vs. Medicaid/Medicare). Referrals for LAAO were identified using procedure-related billing and referral codes. Patients with missing race or insurance data were excluded. Chi-square tests were used to compare referral rates across groups, with statistical significance set at p &lt; 0.05. Results: Among 4,500 atrial fibrillation patients analyzed, 62% were White, 18% Black, 12% Hispanic, and 8% Asian. Overall, referral rates for LAAO were significantly higher among patients with private insurance (68%) compared to those with Medicaid/Medicare (47%) (p &lt; 0.01). Referral disparities were evident across all racial groups. Among White patients, referral rates were 72% (private) vs. 50% (Medicaid/Medicare); for Black patients, 58% vs. 35%; for Hispanic patients, 60% vs. 38%; and for Asian patients, 65% vs. 42%, respectively. Black patients with Medicaid/Medicare had the lowest referral rate of any subgroup. Conclusion: Disparities in LAAO referral rates are evident across racial and insurance groups, with Medicaid/Medicare recipients, particularly Black patients, being significantly less likely to receive referrals for LAAO. Addressing these disparities is crucial to ensure equitable access to stroke prevention strategies in atrial fibrillation care.

Background: PCSK9 inhibitors significantly reduce LDL-C levels and cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD), particularly following acute coronary syndromes (ACS) and in those with familial hypercholesterolemia (FH). However, equitable inpatient access to these therapies remains unclear. Objective: To assess racial and socioeconomic disparities in inpatient utilization of PCSK9 inhibitors among patients hospitalized with ASCVD, with a focus on post-ACS and FH subgroups. Methods: We conducted a retrospective cross-sectional study using the National Inpatient Sample (NIS) from 2020 to 2022. Adult hospitalizations with a diagnosis of ASCVD, including ACS and FH, were identified using ICD-10 codes. Inpatient PCSK9 inhibitor use was determined by pharmacy billing codes. Patients were stratified by race/ethnicity and income quartile. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) for PCSK9i utilization, controlling for demographics, insurance, comorbidities, and hospital-level factors. Results: Among 180,000 weighted ASCVD hospitalizations, only 1.3% received PCSK9 inhibitors. Black (aOR 0.58, 95% CI 0.50–0.68) and Hispanic (aOR 0.61, 95% CI 0.52–0.72) patients were significantly less likely than White patients to receive PCSK9is. Patients in the lowest income quartile had 47% lower odds of treatment compared to the highest (aOR 0.53, 95% CI 0.45–0.63). In post-ACS patients, PCSK9i use was 2.1% for White vs. 0.9% for Black patients. Similar trends were observed in FH patients. Conclusion: Inpatient use of PCSK9 inhibitors remains extremely limited and disproportionately lower among Black, Hispanic, and low-income patients with ASCVD. These findings highlight critical disparities in access to high-efficacy lipid-lowering therapy and underscore the need for equitable inpatient prescribing practices.

Introduction/Background: Renal denervation (RDN) is an upcoming interventional procedure for resistant hypertension. However, most major RDN trials have disproportionality in enrolled participants, with limited representation of Black, Asian, or Hispanic populations. Whether RDN efficacy varies across ethnic groups, or if underrepresentation hinders generalizability, remains a critical question in cardiovascular research. Research Questions/Hypothesis: We evaluated the level of racial and ethnic representation in RDN trials and explored differences in systolic blood pressure (SBP) reduction across ethnic subgroups. We hypothesized that both disparities in enrollment and potential outcome differences would be evident. Methods/Approach: A meta-review was conducted of six studies with available ethnic subgroup data: SYMPLICITY HTN-3, REQUIRE Trial, SPYRAL HTN-OFF MED, RADIANCE-HTN TRIO, SYMPLICITY Global Registry (Asian cohort), and a Chinese RDN registry study. We extracted SBP outcomes by ethnicity (Black, Asian, White) when reported, and recorded sample sizes and responder trends. Due to heterogeneity and limited quantitative subgroup data, a pooled mean difference was not calculated. Instead, descriptive synthesis and cross-study comparisons were performed. Results/Data: Ethnic subgroup reporting was limited across RDN trials. SYMPLICITY HTN-3 included 24% Black patients with SBP reduction of –12.5 mmHg vs –15.5 mmHg in White patients; no significant interaction reported. REQUIRE (100% Asian) showed modest SBP drop of –6.6 mmHg with no superiority over sham. The SYMPLICITY Global Registry (&gt;800 Asians) showed consistent SBP reductions of about 15 mmHg. The Chinese Registry reported SBP reductions (–10 to –20 mmHg) without a comparator. SPYRAL HTN-OFF MED and RADIANCE-HTN TRIO lacked ethnicity-stratified data and enrolled mostly White/European cohorts. Minority representation and subgroup analyses were limited, restricting comparative conclusions. Conclusion(s): This review highlights a critical gap in both representation and reporting of ethnic subgroup outcomes in RDN trials. Available data suggest that RDN is effective in Asian and Black patients, but sample sizes and statistical rigor remain insufficient to confirm differential efficacy. Greater inclusion and mandatory ethnicity-stratified analyses in future trials are essential to ensure equitable, evidence-based use of RDN across diverse populations.

Background: Stroke-related mortality has been rising in the United States. Understanding its association with modifiable risk factors, such as hyperlipidemia (HLD), is critical for prevention. This study analyzes trends and disparities in stroke-related mortality among patients with HLD in the United States from 1999 to 2020. Methods: Using data from CDC WONDER (Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research), we calculated annual stroke-related age-adjusted mortality rates (AAMR) per 100,000 in patients with HLD from 1999 to 2020 and stratified them by sex and race. Stroke-related deaths were defined as those with stroke (ICD-10 I60–I69) as the underlying cause and hyperlipidemia listed as a contributing condition. JoinPoint regression analysis was used to assess trends and estimate annual percent changes (APC). Results: From 1999 to 2020, there were 58,661 stroke-related deaths in patients with HLD, with an overall AAMR of 0.8 per 100,000. AAMR increased throughout the period, rising rapidly from 0.3 in 1999 to 0.7 in 2006 (APC +13.7%, p &lt;0.001), followed by a slower increase to 1.2 in 2020 (APC +2.8%, p =0.002). Female and male patients exhibited similar trends. AAMR was 0.3 for both sexes in 1999 and rose to 1.1 in females and 1.2 in males by 2020. Initially, Black or African American patients and White patients had similar AAMRs; however, AAMR increased more rapidly in Black patients compared to White patients. Among Black patients, AAMR rose from 0.2 in 1999 to 0.7 in 2004 (APC +24.6%, p &lt;0.001), then further increased to 1.4 in 2020 (APC +4.2%, p =0.001). In White patients, AAMR rose from 0.2 in 1999 to 0.7 in 2006 (APC +13.7%, p &lt;0.001) and to 1.1 in 2020 (APC +2.6%, p &lt;0.001). Conclusion: Stroke-related mortality in patients with HLD increased steadily from 1999 to 2020. Trends were similar between male and female patients. However, AAMR rose more rapidly among Black patients than White patients, underscoring growing disparities.