Underutilization of Transcatheter Aortic Valve Replacement in Northern Plains American Indians with Severe Aortic Stenosis - Journal of Racial and Ethnic Health Disparities
Source : https://link.springer.com/article/10.1007/s40615-023-01604-7
Introduction Transcatheter aortic valve replacement (TAVR) has overtaken surgical aortic valve replacement and revolutionized the treatment strategy for aortic valve replacement. Little is known on the disparities among minorities, especially American Indians (AI), undergoing this procedure. We explore TAVR outcomes to identify disparities at our institution.
Conclusions: AI undergoing TAVR presented earlier, with higher rates of diabetes and smoking, lower STS risk scores, and lesser aortic valve gradients than C/W. The number of TAVR procedures performed on AI from North Dakota was lower than anticipated despite a nearly 10-year period and the disparities experienced by AI who could have otherwise benefited from TAVR.
• Source: Journal of Racial and Ethnic Health Disparities\
• Conclusions: “AI [American Indians] undergoing TAVR presented earlier, with higher rates of diabetes and smoking, lower STS risk scores, and lesser aortic valve gradients than C/W [Caucasian/White]. The number of TAVR procedures performed on AI from North Dakota was lower than anticipated despite a nearly 10-year period and the disparities experienced by AI who could have otherwise benefited from TAVR.”
• In the current retrospective chart review involving 1153 patients (20 AI) who received TAVR, U.S. researchers found that when compared with White patients, AI patients presented at an earlier age, had a higher risk of smoking, and had lower Society of Thoracic Surgery (STS) risk scores and aortic-valve mean gradients (42.8 mmHg vs. 47.5 mmHg; P = .010). AI had shorter lifespans post-TAVR vs. White patients. AI also received fewer TAVR than expected (4 performed vs. 32 expected; P < .001).
• Short-term outcomes following TAVR secondary to severe aortic stenosis are good in both White and AI patients. Reduced early survival in AI patients could be due to increased rates of smoking and increased rates of diabetes, as well as decreased access to care and follow-up.
• The authors wrote, “Identifying ‘surgical deserts’ such as rural areas, reservations, or Indian Health Service facilities prospectively may identify patients at risk for inadequate follow-up after procedures, including TAVR,” the authors wrote. “Other factors influencing patient health such as employment and housing status, health care literacy, and insurance coverage are also important.”