Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Division of Cardiac Surgery, Yale School of Medicine, New Haven, Conn.
Am J Med. 2024 Apr;137(4):321-330.e7. doi: 10.1016/j.amjmed.2023.12.026. Epub 2024 Jan 6.
There are concerns that transcatheter or surgical aortic valve replacement (TAVR/SAVR) procedures are preferentially available to White patients. Our objective was to examine differences in utilization of aortic valve replacement and outcomes by race/ethnicity in the US for patients with aortic stenosis.
We performed a serial cross-sectional cohort study of 299,976 Medicare beneficiaries hospitalized with principal diagnosis of aortic stenosis between 2012 and 2019 stratified by self-reported race/ethnicity (Black, Hispanic, Asian, Native American, and White). Outcomes included aortic valve replacement rates within 6 months of index hospitalization and associated procedural outcomes, including 30-day readmission, 30-day and 1-year mortality.
Within 6 months of an index admission for aortic stenosis, 86.8% (122,457 SAVR; 138,026 TAVR) patients underwent aortic valve replacement. Overall, compared with White people, Black (HR 0.87 [0.85-0.89]), Hispanic (0.92 [0.88-0.96]), and Asian (0.95 [0.91-0.99]) people were less likely to receive aortic valve replacement. Among patients who were admitted emergently/urgently, White patients (41.1%, 95% CI, 40.7-41.4) had a significantly higher aortic valve replacement rate compared with Black (29.6%, 95% CI, 28.3-30.9), Hispanic (36.6%, 95% CI, 34.0-39.3), and Asian patients (35.4%, 95% CI, 32.3-38.9). Aortic valve replacement rates increased annually for all race/ethnicities. There were no significant differences in 30-day or 1-year mortality by race/ethnicity.
Aortic valve replacement rates within 6 months of aortic stenosis admission are lower for Black, Hispanic, and Asian people compared to White people. These race-related differences in aortic stenosis treatment reflect complex issues in diagnosis and management, warranting a comprehensive reassessment of the entire care spectrum for disadvantaged populations.
有人担心经导管主动脉瓣置换术（TAVR/SAVR）或手术主动脉瓣置换术（TAVR/SAVR）优先提供给白人患者。我们的目的是在美国，检查种族/族裔之间主动脉瓣狭窄患者主动脉瓣置换术和结局的利用差异。
我们对 2012 年至 2019 年期间因主动脉瓣狭窄住院的 299976 名医疗保险受益人的连续横断面队列进行了研究，这些患者按自我报告的种族/族裔（黑人、西班牙裔、亚洲人、美洲原住民和白人）进行分层。结果包括主动脉瓣狭窄指数住院后 6 个月内的主动脉瓣置换率以及相关的手术结果，包括 30 天再入院、30 天和 1 年死亡率。
在主动脉瓣狭窄指数住院后 6 个月内，86.8%（122457 例 SAVR；138026 例 TAVR）的患者接受了主动脉瓣置换术。总体而言，与白人相比，黑人（HR 0.87 [0.85-0.89]）、西班牙裔（0.92 [0.88-0.96]）和亚洲人（0.95 [0.91-0.99]）接受主动脉瓣置换术的可能性较低。在紧急/紧急入院的患者中，白人患者（41.1%，95%CI，40.7-41.4）的主动脉瓣置换率明显高于黑人（29.6%，95%CI，28.3-30.9）、西班牙裔（36.6%，95%CI，34.0-39.3）和亚洲人（35.4%，95%CI，32.3-38.9）。所有种族/族裔的主动脉瓣置换率逐年上升。种族/族裔之间的 30 天或 1 年死亡率没有显著差异。
与白人相比，黑人、西班牙裔和亚洲人在主动脉瓣狭窄入院后 6 个月内的主动脉瓣置换率较低。主动脉瓣狭窄治疗中这些与种族相关的差异反映了诊断和管理方面的复杂问题，需要对劣势人群的整个护理范围进行全面重新评估。
