African American-Caucasian American Differences in Aortic Valve Replacement in Patients with Severe Aortic Stenosis

Overview

Journal Am Heart J

Specialty Cardiology & Vascular Diseases

Date 2021 Jan 16

PMID 33453161

Citations 2

Authors

George S Yankey Jr

Larry R Jackson 2nd

Colin Marts

Karen Chiswell

Angie Wu

Francis Ugowe

Jimica Wilson

Sreekanth Vemulapalli

Zainab Samad

Kevin L Thomas

Affiliations

Soon will be listed here.

Abstract

Background: Among patients with severe aortic stenosis (AS), there are limited data on aortic valve replacement (AVR), reasons for nonreceipt and mortality by race.

Methods: Utilizing the Duke Echocardiography Laboratory Database, we analyzed data from 110,711 patients who underwent echocardiography at Duke University Medical Center between 1999 and 2013. We identified 1,111 patients with severe AS who met ≥1 of 3 criteria for AVR: ejection fraction ≤50%, diagnosis of heart failure, or need for coronary artery bypass surgery. Logistic regression models were used to assess the association between race, AVR and 1-year mortality. χ2 testing was used to assess potential racial differences in reasons for AVR nonreceipt.

Results: Among the 1,111 patients (143 AA and 968 CA) eligible for AVR, AA were more often women, had more diabetes, renal insufficiency, aortic regurgitation and left ventricular hypertrophy. CA were more often smokers, had more ischemic heart disease, hyperlipidemia and higher median income levels. There were no racial differences in surgical risk utilizing logistic euroSCORES. Relative to CA, AA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) yet similar 1-year mortality (aHR 0.81, 95% CI 0.57-1.17, P = .262). There were no significant differences in reasons for AVR nonreceipt.

Conclusions: We identified 143 African Americans (AA) and 968 Caucasian Americans(CA) with severe AS who met prespecified criteria for AVR.. AA relative to CA were more often women, had more diabetes, renal insufficiency, and left ventricular hypertrophy, however had less tobacco use, ischemic heart disease, hyperlipidemia and lower median income levels. Among patients with severe AS, AA relative to CA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) without significant differences in reasons for AVR nonreceipt and similar 1-year mortality.

Citing Articles

Racial, Ethnic, and Gender Disparities in Valvular Heart Failure Management.

Ilonze O, Free K, Shinnerl A, Lewsey S, Breathett K Heart Fail Clin. 2023; 19(3):379-390.

PMID: 37230651 PMC: 10614031. DOI: 10.1016/j.hfc.2023.02.009.

Racial and Ethnic Disparities in Aortic Stenosis.

Parikh P, Kort S J Am Heart Assoc. 2022; 11(24):e028131.

PMID: 36533614 PMC: 9798795. DOI: 10.1161/JAHA.122.028131.

References

McNeely C, Zajarias A, Fohtung R, Kakouros N, Walker J, Robbs R . Racial Comparisons of the Outcomes of Transcatheter and Surgical Aortic Valve Implantation Using the Medicare Database. Am J Cardiol. 2018; 122(3):440-445. DOI: 10.1016/j.amjcard.2018.04.019. View

Patel D, Green K, Fudim M, Harrell F, Wang T, Robbins M . Racial differences in the prevalence of severe aortic stenosis. J Am Heart Assoc. 2014; 3(3):e000879. PMC: 4309086. DOI: 10.1161/JAHA.114.000879. View

EDWARDS F, Clark R, Schwartz M . Coronary artery bypass grafting: the Society of Thoracic Surgeons National Database experience. Ann Thorac Surg. 1994; 57(1):12-9. DOI: 10.1016/0003-4975(94)90358-1. View

Barreto-Filho J, Wang Y, Dodson J, Desai M, Sugeng L, Geirsson A . Trends in aortic valve replacement for elderly patients in the United States, 1999-2011. JAMA. 2013; 310(19):2078-85. PMC: 4089974. DOI: 10.1001/jama.2013.282437. View

Taylor N, OBrien S, Edwards F, Peterson E, Bridges C . Relationship between race and mortality and morbidity after valve replacement surgery. Circulation. 2005; 111(10):1305-12. DOI: 10.1161/01.CIR.0000157737.92938.D8. View

Beydoun H, Beydoun M, Liang H, Dore G, Shaked D, Zonderman A . Sex, Race, and Socioeconomic Disparities in Patients With Aortic Stenosis (from a Nationwide Inpatient Sample). Am J Cardiol. 2016; 118(6):860-865. PMC: 5822040. DOI: 10.1016/j.amjcard.2016.06.039. View

Stewart B, Siscovick D, Lind B, Gardin J, Gottdiener J, Smith V . Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997; 29(3):630-4. DOI: 10.1016/s0735-1097(96)00563-3. View

Varadarajan P, Kapoor N, Bansal R, Pai R . Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann Thorac Surg. 2006; 82(6):2111-5. DOI: 10.1016/j.athoracsur.2006.07.048. View

Califf R, Harrell Jr F, Lee K, Rankin J, Hlatky M, Mark D . The evolution of medical and surgical therapy for coronary artery disease. A 15-year perspective. JAMA. 1989; 261(14):2077-86. View

10.

Boyle C, DECOUFLE P . National sources of vital status information: extent of coverage and possible selectivity in reporting. Am J Epidemiol. 1990; 131(1):160-8. DOI: 10.1093/oxfordjournals.aje.a115470. View

11.

Ugowe F, Jackson 2nd L, Thomas K . Racial and ethnic differences in the prevalence, management, and outcomes in patients with atrial fibrillation: A systematic review. Heart Rhythm. 2018; 15(9):1337-1345. DOI: 10.1016/j.hrthm.2018.05.019. View

12.

Mark D, Nelson C, Califf R, Harrell Jr F, Lee K, Jones R . Continuing evolution of therapy for coronary artery disease. Initial results from the era of coronary angioplasty. Circulation. 1994; 89(5):2015-25. DOI: 10.1161/01.cir.89.5.2015. View

13.

Popma J, Deeb G, Yakubov S, Mumtaz M, Gada H, OHair D . Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med. 2019; 380(18):1706-1715. DOI: 10.1056/NEJMoa1816885. View

14.

Braunwald E . On the natural history of severe aortic stenosis. J Am Coll Cardiol. 1990; 15(5):1018-20. DOI: 10.1016/0735-1097(90)90235-h. View

15.

Brown J, OBrien S, Wu C, Sikora J, Griffith B, Gammie J . Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg. 2009; 137(1):82-90. DOI: 10.1016/j.jtcvs.2008.08.015. View

16.

Bhatti F, Grayson A, Grotte G, Fabri B, Au J, Jones M . The logistic EuroSCORE in cardiac surgery: how well does it predict operative risk?. Heart. 2006; 92(12):1817-20. PMC: 1861312. DOI: 10.1136/hrt.2005.083204. View

17.

Murugiah K, Wang Y, Dodson J, Nuti S, Dharmarajan K, Ranasinghe I . Trends in hospitalizations among medicare survivors of aortic valve replacement in the United States from 1999 to 2010. Ann Thorac Surg. 2014; 99(2):509-17. PMC: 4454375. DOI: 10.1016/j.athoracsur.2014.08.045. View

18.

Rodriguez B, Acharya P, Salazar-Fields C, Horne Jr A . Comparison of Frequency of Referral to Cardiothoracic Surgery for Aortic Valve Disease in Blacks, Hispanics, and Whites. Am J Cardiol. 2017; 120(3):450-455. DOI: 10.1016/j.amjcard.2017.04.048. View

19.

Ersboll M, Schulte P, Al Enezi F, Shaw L, Kober L, Kisslo J . Predictors and progression of aortic stenosis in patients with preserved left ventricular ejection fraction. Am J Cardiol. 2014; 115(1):86-92. DOI: 10.1016/j.amjcard.2014.09.049. View

20.

Harris P, Lee K, Harrell Jr F, BEHAR V, Rosati R . Outcome in medically treated coronary artery disease. Ischemic events: nonfatal infarction and death. Circulation. 1980; 62(4):718-26. DOI: 10.1161/01.cir.62.4.718. View