Pre-procedural barriers to accessing novel treatments for aortic stenosis among racial/ethnic minorities in the veterans affairs healthcare system

American Heart Journal Plus

Celina M. Yong¹  Ashwini Kerkar²  Paul A. Heidenreich²  Santosh Gummidipundi³ 

[1] Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA;Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, Stanford, CA, USA;Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA;

关键词: Aortic stenosis;    TAVR;    SAVR;    Disparities;    Race;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Novel structural heart procedures offer life-saving treatment advantages, yet little is known about pre-procedural barriers to care by race/ethnicity. Methods: All echocardiograms performed at a Veterans Affairs hospital from 2015 to 2019 were reviewed to identify patients with severe aortic stenosis and their access to transcatheter aortic valve replacement (TAVR) by race/ethnicity. Results: From 19,403 echocardiograms, 355 individuals were identified to have severe aortic stenosis (72.6% White, 9.8% Hispanic, 3.9% Black). There was a non-significant trend towards increased TAVR treatment among White compared to non-White patients (OR 2.02, CI 0.96–4.24, p = 0.063), which attenuated after adjustment for age and comorbidities. Reasons for not undergoing replacement included poor procedural candidacy (25.3%), loss of follow-up (17.8%), and patient refusal (16.4%). Conclusions: Racial/ethnic inequities were not detected in novel structural heart treatment within the VA. However, a high proportion of eligible patients did not receive procedural treatment due to patient refusal or loss of follow-up, highlighting barriers that require further study.

【 授权许可】

Unknown