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Racial Differences in the Use of Aortic Valve Replacement for Treatment of Symptomatic Severe Aortic Valve Stenosis in the Transcatheter Aortic Valve Replacement Era.

Publication ,  Journal Article
Matthew Brennan, J; Leon, MB; Sheridan, P; Boero, IJ; Chen, Q; Lowenstern, A; Thourani, V; Vemulapalli, S; Thomas, K; Wang, TY; Peterson, ED
Published in: J Am Heart Assoc
August 18, 2020

Background Aortic valve replacement (AVR) is a life-saving treatment for patients with symptomatic severe aortic valve stenosis. We sought to determine whether transcatheter AVR has resulted in a more equitable treatment rate by race in the United States. Methods and Results A total of 32 853 patients with symptomatic severe aortic valve stenosis were retrospectively identified via Optum's deidentified electronic health records database (2007-2017). AVR rates in non-Hispanic Black and White patients were assessed in the year after diagnosis. Multivariate Fine-Gray hazards models were used to evaluate the likelihood of AVR by race, with adjustment for patient factors and the managing cardiologist. Time-trend and 1-year symptomatic severe aortic valve stenosis survival analyses were also performed. From 2011 to 2016, the rate of AVR increased from 20.1% to 37.1%. Overall, Black individuals were less likely than Whites to receive AVR (22.9% versus 31.0%; unadjusted hazard ratio [HR], 0.70; 95% CI, 0.62-0.79; fully adjusted HR, 0.76; 95% CI, 0.67-0.85). Yet, during 2015 to 2016, AVR racial differences were attenuated (29.5% versus 35.2%; adjusted HR, 0.86; 95% CI, 0.74-1.02) because of greater uptake of transcatheter AVR in Blacks than Whites (53.4% of AVRs versus 47.3%; P=0.128). Untreated patients had significantly higher 1-year mortality than those treated (adjusted HR, 0.57; 95% CI, 0.53-0.61), which was consistent by race (interaction P value=0.52). Conclusions Although transcatheter AVR has increased the use of AVR in the United States, treatment rates remain low. Black patients with symptomatic severe aortic valve stenosis were less likely than White patients to receive AVR, yet these differences have recently narrowed.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

August 18, 2020

Volume

9

Issue

16

Start / End Page

e015879

Location

England

Related Subject Headings

  • White People
  • United States
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Symptom Assessment
  • Survival Analysis
  • Multivariate Analysis
  • Male
  • Income
  • Humans
 

Citation

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ICMJE
MLA
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Matthew Brennan, J., Leon, M. B., Sheridan, P., Boero, I. J., Chen, Q., Lowenstern, A., … Peterson, E. D. (2020). Racial Differences in the Use of Aortic Valve Replacement for Treatment of Symptomatic Severe Aortic Valve Stenosis in the Transcatheter Aortic Valve Replacement Era. J Am Heart Assoc, 9(16), e015879. https://doi.org/10.1161/JAHA.119.015879
Matthew Brennan, J., Martin B. Leon, Paige Sheridan, Isabel J. Boero, Qinyu Chen, Angela Lowenstern, Vinod Thourani, et al. “Racial Differences in the Use of Aortic Valve Replacement for Treatment of Symptomatic Severe Aortic Valve Stenosis in the Transcatheter Aortic Valve Replacement Era.J Am Heart Assoc 9, no. 16 (August 18, 2020): e015879. https://doi.org/10.1161/JAHA.119.015879.
Matthew Brennan J, Leon MB, Sheridan P, Boero IJ, Chen Q, Lowenstern A, et al. Racial Differences in the Use of Aortic Valve Replacement for Treatment of Symptomatic Severe Aortic Valve Stenosis in the Transcatheter Aortic Valve Replacement Era. J Am Heart Assoc. 2020 Aug 18;9(16):e015879.
Matthew Brennan, J., et al. “Racial Differences in the Use of Aortic Valve Replacement for Treatment of Symptomatic Severe Aortic Valve Stenosis in the Transcatheter Aortic Valve Replacement Era.J Am Heart Assoc, vol. 9, no. 16, Aug. 2020, p. e015879. Pubmed, doi:10.1161/JAHA.119.015879.
Matthew Brennan J, Leon MB, Sheridan P, Boero IJ, Chen Q, Lowenstern A, Thourani V, Vemulapalli S, Thomas K, Wang TY, Peterson ED. Racial Differences in the Use of Aortic Valve Replacement for Treatment of Symptomatic Severe Aortic Valve Stenosis in the Transcatheter Aortic Valve Replacement Era. J Am Heart Assoc. 2020 Aug 18;9(16):e015879.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

August 18, 2020

Volume

9

Issue

16

Start / End Page

e015879

Location

England

Related Subject Headings

  • White People
  • United States
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Symptom Assessment
  • Survival Analysis
  • Multivariate Analysis
  • Male
  • Income
  • Humans