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Pre-procedural Barriers to Accessing Novel Treatments for Aortic Stenosis Among Racial/ethnic Minorities in the Veterans Affairs Healthcare System

Overview
Journal Am Heart J Plus
Specialty Cardiology & Vascular Diseases
Date 2024 Apr 1
PMID 38560411
Authors
Ashwini Kerkar
Santosh Gummidipundi
Paul A Heidenreich
Celina M Yong
Affiliations
Soon will be listed here.
Abstract

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,  = 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.

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