Post on 23-Mar-2022
Despite similar prevalence of aortic stenosis, utilization rates of life-saving aortic valve
replacement therapy were much lower in women and blacks compared with men and whites,
respectively in the US during 2012-2017. 1-year mortality rates for TAVR improved across all
subgroups during the study period.
Aakriti Gupta, Yun Wang, Torsten Vahl, Ajay Kirtane,
Makoto Mori, Isaac George, Susheel Kodali, Martin Leon, Harlan Krumholz
NewYork-Presbyterian Hospital and the Columbia University Irving Medical Center, New York, NY, USA Yale-New Haven Hospital, New Haven, CT, USA
RESULTS
Study population From 100% Medicare Fee-for-Service beneficiaries hospitalized between 2012 and 2017, we included patients with ICD-9 and 10 procedure codes for TAVR and SAVR. Outcomes We report operative rates per 1 000 000 person-years and outcomes including in-hospital mortality, discharge disposition, length-of-stay (LOS) and 1-year mortality rates stratified by sex and race.
The availability of both transcatheter and surgical aortic valve replacement (TAVR and SAVR) has revolutionized the care of elderly patients with aortic stenosis, particularly since TAVR was first approved in 2011. It remains unknown, however, whether dissemination of this technology has been equitable.
• Rates of both SAVR and TAVR were much lower in women and blacks compared with men and whites, respectively, and the difference was more pronounced for SAVR with rates in women half that in men, and blacks half that in whites (Figure).
• In-hospital and 1-year mortality improved for all subgroups through the study period.
• Compared with men, women had consistently worse in-hospital mortality but better 1-year mortality rates for TAVR. For SAVR, both in-hospital and 1-year mortality rates were worse in women.
• While 1-year mortality rates were comparable between white and black patients undergoing TAVR, black patients undergoing SAVR had consistently worse 1-year mortality rates compared with whites.
• Women and blacks were more likely to be discharged to skilled nursing facilities compared with men and whites, respectively.
• Length-of-stay for TAVR improved for all subgroups through the study period.
CONCLUSION
METHODS
FIGURE 3
Sex- and Race-based Differences Among Medicare
Beneficiaries Undergoing Transcatheter and Surgical
Aortic Valve Replacement in the United States, 2012-2017
• Utilization rates of both SAVR and TAVR were much lower in women and blacks compared with men and whites during the study period
• While outcomes for SAVR remained stable, in-hospital outcomes and 1-year mortality related to TAVR improved for all subgroups through the study period.
• Efforts to minimize treatment disparities should focus on mitigating barriers to both TAVR and SAVR.
To examine race- and sex-specific trends in utilization and outcomes for Medicare beneficiaries receiving TAVR and SAVR during 2012-2017
OBJECTIVE
BACKGROUND
IN-HOSPITAL OUTCOMES
DISCLOSURE INFORMATION
16 27
38 53
73
90 82 80 73
67 58
49
22 35
52
70
101
125
156 160 151
142 128
112
2012 2013 2014 2015 2016 2017
Sex-specific AVR hospitalization rates per 100,000
Female_TAVR Female_SAVR Male_TAVR Male_SAVR
8 12 18
25 35
45
21
34
49
67
96
118
50 48 47
44 37 35
126 127 119 111
99
85
2012 2013 2014 2015 2016 2017
Race-specific AVR hospitalization rates per 100,000
Black_TAVR White_TAVR Black_SAVR White_SAVR
13.2 13.9
10.4 12.5
14.1 10.8
10.7 10
8.1 9.1 8.5 8.4
17.6
15.2
12 13.5
12.4 11
20.6
17.3
11.8 13.6
11.1 10.1
2012 2013 2014 2015 2016 2017
Race-specific 1-year mortality (%) SAVR_Black SAVR_White TAVR_Black TAVR_White
11.7 11
9.3 10.2 9.8 10 10.2
9.6 7.5 8.6 8.1 7.6
19.6 16.5
11.5 12.5
10.2 9.3
21.2
17.8
12
14.4 12
10.7
2012 2013 2014 2015 2016 2017
Sex-specific 1-year mortality (%) SAVR_female SAVR_male TAVR_female TAVR_male
Dr. Gupta is supported by NIH training grant T32 HL007854. Dr. Gupta reports consulting fees from Edwards Lifesciences and received payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation and from the Ben C. Martin Law Firm for work related to the Cook inferior vena cava filter litigation. Dr. Gupta holds equity in a healthcare telecardiology startup, Heartbeat Health, Inc.